Customer Satisfaction Survey

We are always doing our best to improve and we carefully review all of the input we receive.

Location Preference:

Preferred Optometrist:

You can slide the Survey Form Left or Right to view all the content.

	Great	Good	Fair	Poor	N/A
Communication prior to appointment
Appointment availability
Waiting room time
Fees
Quality of care from staff
Quality of care from doctor
Overall quality of care
Concerns or questions answered

Preferred Appointment Day:

Preferred Appointment Time:

Do you plan on returning for your next comprehensive examination?

YesNo

Would you schedule appointments online?

YesNo

Eyeglasses Range:

Identifications

(Optional)

	Great	Good	Fair	Poor	N/A
Satisfaction with eyeglasses
Satisfaction with contact lenses