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Service Ratings
Communication 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
Scheduling
Preferred day for appointments:
No Preference
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred time for appointments:
No Preference
7am - 9am
9am - 5pm
5pm - 8pm
8pm - 10pm
Do you plan on returning for your next comprehensive examination?:
Yes
No
For no, please tell us why not.
Would you schedule appointments online?
Yes
No
Products
Satisfaction with eyeglasses:
Great
Good
Fair
Poor
N/A
Satisfaction with contact lenses:
Great
Good
Fair
Poor
N/A
Range of eyeglasses selection:
Good
Too Few
Too Many
Too Many Of The Same Type
Identification (Optional)
Your Name
Your Email
Why did you choose us for your eye health care?
Additional comments