Satisfaction Survey Please let us know how your last visit went.Service RatingsCommunication prior to appointmentGreatGoodFairPoorN/AAppointment availabilityGreatGoodFairPoorN/AWaiting room timeGreatGoodFairPoorN/AFeesGreatGoodFairPoorN/AQuality of care from staffGreatGoodFairPoorN/AQuality of care from doctorGreatGoodFairPoorN/AConcerns or questions answeredGreatGoodFairPoorN/AOverall quality of careGreatGoodFairPoorN/ASchedulingPreferred day for appointmentsSelect preferred day for appointments >SundayMondayTuesdayWednesdayThursdayFridaySaturdayNo preferencePreferred time for appointmentsSelect preferred time for appointments >7 am to 9 am9 am to 5 pm5 pm to 8 pm8 pm to 10 pmNo preferenceDo you plan on returning for your next comprehensive examination?YesNoPlease tell us why notWould you schedule appointments online?YesNoPlease tell us why notProductsSatisfaction with eyeglassesGreatGoodFairPoorN/ASatisfaction with contact lensesGreatGoodFairPoorN/ARange of eyeglasses selectionSelect range of eyeglasses selection >GoodToo FewToo ManyToo many of the same typeIdentification - This section is optional.Why did you choose us for your eye health care?Your Name (Optional) First Last Additional commentsCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
