How was your Advanced Eye Care visit? Survey

1. Which doctor did you see?

Which doctor did you see?

2. How satisfied were you with your eye examination?

	Very Satisfied	Satisfied	Unsatisfied	Very unsatisfied
Please click one button:	*How satisfied were you with your eye examination? Please click one button: Very Satisfied	Please click one button: Satisfied	Please click one button: Unsatisfied	Please click one button: Very unsatisfied

Comment

3. What insurance did you use in our office?

What insurance did you use in our office?

4. Were your insurance needs/questions properly handled by our office?

Were your insurance needs/questions properly handled by our office? Yes

No

Comment

5. If you purchased eyeglasses, how satisfied were you with your eyeglass purchase?

	Very Satisfied	Satisfied	Unsatisfied	Very unsatisfied
Click one:	*If you purchased eyeglasses, how satisfied were you with your eyeglass purchase? Click one: Very Satisfied	Click one: Satisfied	Click one: Unsatisfied	Click one: Very unsatisfied

Comment

6. If you purchased contact lenses from this office,how satisifed were you with your contact lens purchase?

	Very Satisfied	Satisfied	Unsatisfied	Very Unsatisfied
Click one	* If you purchased contact lenses from this office,how satisifed were you with your contact lens purchase? Click one Very Satisfied	Click one Satisfied	Click one Unsatisfied	Click one Very Unsatisfied

Comment

7. Rate the courtesy/helpfulness of the following people that assisted you:

	Very Satisfied	Satisfied	Unsatisfied	Very Unsatisfied
The person that initially scheduled you appointment	*Rate the courtesy/helpfulness of the following people that assisted you: The person that initially scheduled you appointment Very Satisfied	The person that initially scheduled you appointment Satisfied	The person that initially scheduled you appointment Unsatisfied	The person that initially scheduled you appointment Very Unsatisfied
The person that greeted you when you arrived in the office	The person that greeted you when you arrived in the office Very Satisfied	The person that greeted you when you arrived in the office Satisfied	The person that greeted you when you arrived in the office Unsatisfied	The person that greeted you when you arrived in the office Very Unsatisfied
The technician that assisted you	The technician that assisted you Very Satisfied	The technician that assisted you Satisfied	The technician that assisted you Unsatisfied	The technician that assisted you Very Unsatisfied
The doctor that examined you	The doctor that examined you Very Satisfied	The doctor that examined you Satisfied	The doctor that examined you Unsatisfied	The doctor that examined you Very Unsatisfied
The doctor's assistant	The doctor's assistant Very Satisfied	The doctor's assistant Satisfied	The doctor's assistant Unsatisfied	The doctor's assistant Very Unsatisfied
The contact lens assistant	The contact lens assistant Very Satisfied	The contact lens assistant Satisfied	The contact lens assistant Unsatisfied	The contact lens assistant Very Unsatisfied
The optician	The optician Very Satisfied	The optician Satisfied	The optician Unsatisfied	The optician Very Unsatisfied
The check-out desk	The check-out desk Very Satisfied	The check-out desk Satisfied	The check-out desk Unsatisfied	The check-out desk Very Unsatisfied

Comment

8. How satisfied were you overall with the experience in our office?

	Very Satisfied	Satisfied	Unsatisfied	Very Unsatisfied
Click one	*How satisfied were you overall with the experience in our office? Click one Very Satisfied	Click one Satisfied	Click one Unsatisfied	Click one Very Unsatisfied

Comment

9.
Do you have any suggestions to improve the quality of the eye care that you received?

Do you have any suggestions to improve the quality of the eye care that you received?

10.
Would you recommend this office to a friend?

Would you recommend this office to a friend? Yes	No
Comment

How was your Advanced Eye Care visit?Exit the survey

1. Which doctor did you see?

2. How satisfied were you with your eye examination?

3. What insurance did you use in our office?

4. Were your insurance needs/questions properly handled by our office?

5. If you purchased eyeglasses, how satisfied were you with your eyeglass purchase?

6. If you purchased contact lenses from this office,how satisifed were you with your contact lens purchase?

7. Rate the courtesy/helpfulness of the following people that assisted you:

8. How satisfied were you overall with the experience in our office?

9. Do you have any suggestions to improve the quality of the eye care that you received?

10. Would you recommend this office to a friend?

How was your Advanced Eye Care visit?
Exit the survey

9.
Do you have any suggestions to improve the quality of the eye care that you received?

10.
Would you recommend this office to a friend?