Satisfaction/Feedback Survey Please take a few moments and let us know what you thought of your last visit… Please let us know how your last visit went.Service RatingsCommunication prior to appointment Great Good Fair Poor N/A Appointment availability Great Good Fair Poor N/A Waiting room time Great Good Fair Poor N/A Fees Great Good Fair Poor N/A Quality of care from staff Great Good Fair Poor N/A Quality of care from doctor Great Good Fair Poor N/A Concerns or questions answered Great Good Fair Poor N/A Overall quality of care Great Good Fair Poor N/A SchedulingPreferred day for appointmentsSundayMondayTuesdayWednesdayThursdayFridaySaturdayNo preferencePreferred time for appointments7 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? Yes No Please tell us why notWould you schedule appointments online? Yes No Please tell us why notProductsSatisfaction with eyeglasses Great Good Fair Poor N/A Satisfaction with contact lenses Great Good Fair Poor N/A Range of eyeglasses selectionGoodToo 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 commentsNameThis field is for validation purposes and should be left unchanged.
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