Patient Survey

Name (optional)

Which office did you visit?

Which doctor performed your eye examination?

Was our office staff pleasant and courteous?

  Yes

  No

Did the receptionist greet you upon
arrival?

  Yes

  No

Was the overall appearance of our office and staff pleasant?

  Yes

  No

Were you seen within a reasonable time after arriving at our office?

  Yes

  No

In the exam room, did the doctor thoroughly explain each test and the results of the eye health examination?

  Yes

  No

Was the time taken during the exam process acceptable?

  Yes

  No

If you purchased eyewear, did you have an adequate selection of frames in all price ranges?

  Yes

  No

Were the opticians and staff in the optical area knowledgeable and helpful in the selection of your eyewear?

  Yes

  No

Overall, were you pleased with the selection and purchase of your eyewear?

  Yes

  No

Would you refer a family member or friend to us for professional care?

  Yes

  No

Please leave additional comments about your experience with The Eye Care Group.

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