LVC Patient Survery Survey

1. Why did you first decide to seek optometric services at our office?

Why did you first decide to seek optometric services at our office? Referral by relative

Referral by another patient

Near home or business

Insurance program

Benefit plan through your employment

Yellow page ad

Other:

2. Was it easy to get an appointment?

Was it easy to get an appointment? Yes

If "No", please explain:

3. When you called our office, how were you treated?

When you called our office, how were you treated? Royally

Courteously

Coldly

Like a poor relative

Other (please specify)

4. Were you warmly greeted when you entered our office?

Were you warmly greeted when you entered our office? Yes

If "No", please explain:

5. When you arrived at our office, how long after your scheduled appointment did you have to wait before seeing the doctor?

When you arrived at our office, how long after your scheduled appointment did you have to wait before seeing the doctor? Less than 10 minutes

11 to 20 minutes

More than 20 minutes

Other (please specify)

6. What is your general impression of the office?

What is your general impression of the office? Beautiful

Nice

Average

Shabby

Comments:

7. During your last visit, how were you treated by members of our office staff?

During your last visit, how were you treated by members of our office staff? Like an old friend

Pleasantly

Indifferently

Cold

Other (please specify)

8. How knowledgeable and professional was our staff?

How knowledgeable and professional was our staff? Well trained and helpful

Somewhat knowledgeable

Not helpful

Comments:

9. Which staff member helped you?

Which staff member helped you? Pete

Kathy

Sasha

Susan

Jane

Other (please specify)

10. Which doctor did you see?

Which doctor did you see? Dr. Kevin Cottrell

Dr. Roger Trudell

11. Please rate me on how "genuinely interested" Dr. Trudell or Dr. Cottrell seemed to be in you as a person?

Please rate me on how "genuinely interested" Dr. Trudell or Dr. Cottrell seemed to be in you as a person? Very interested and concerned

Somewhat interested and concerned

Did not seem to have enough time for me

Other (please specify)

12. During your exam, did you think the doctor adequately explained to you the procedures, the outcome and your treatment options?

During your exam, did you think the doctor adequately explained to you the procedures, the outcome and your treatment options? Yes

If "No", how could the doctor improve?

13. Was the vision exam thorough and comprehensive?

Was the vision exam thorough and comprehensive? Yes

Comments:

14. Did the doctor adequately answer your questions?

Did the doctor adequately answer your questions? Yes

If "No", please explain:

15. Did you receive your eyewear or contacts when promised?

Did you receive your eyewear or contacts when promised? Yes

If "No", please explain:

16. Are you satisfied with the quality of the optical products that you purchased in our office?

Are you satisfied with the quality of the optical products that you purchased in our office? Yes

If "No", please explain:

17. What did you think of our selection of frames?

What did you think of our selection of frames? Great selection of frames

Adequate selection

Could be better

Comments:

18. At your last visit, was your fee itemized and clearly explained to you?

At your last visit, was your fee itemized and clearly explained to you? Yes

If "No", please explain:

19. Did you feel our prices are reasonable and fair?

Did you feel our prices are reasonable and fair? Yes

If "No", please explain:

20. Are our office hours convenient?

Are our office hours convenient? Yes

If "No", please explain:

21. Would you recommend other patients to our office?

Would you recommend other patients to our office? Yes

Comments:

22. Do you have any other comments or suggestions which might help us to improve our service to you? All comments whether negative or positive are appreciated.

Do you have any other comments or suggestions which might help us to improve our service to you? All comments whether negative or positive are appreciated.

23. Optional Information:
Name:
Address:
Email:
Phone Number:

Optional Information: Name: Address: Email: Phone Number:

LVC Patient Survery
Exit this survey

1. Default Section

1. Why did you first decide to seek optometric services at our office?

2. Was it easy to get an appointment?

3. When you called our office, how were you treated?

4. Were you warmly greeted when you entered our office?

5. When you arrived at our office, how long after your scheduled appointment did you have to wait before seeing the doctor?

6. What is your general impression of the office?

7. During your last visit, how were you treated by members of our office staff?

8. How knowledgeable and professional was our staff?

9. Which staff member helped you?

10. Which doctor did you see?

11. Please rate me on how "genuinely interested" Dr. Trudell or Dr. Cottrell seemed to be in you as a person?

12. During your exam, did you think the doctor adequately explained to you the procedures, the outcome and your treatment options?

13. Was the vision exam thorough and comprehensive?

14. Did the doctor adequately answer your questions?

15. Did you receive your eyewear or contacts when promised?

16. Are you satisfied with the quality of the optical products that you purchased in our office?

17. What did you think of our selection of frames?

18. At your last visit, was your fee itemized and clearly explained to you?

19. Did you feel our prices are reasonable and fair?

20. Are our office hours convenient?

21. Would you recommend other patients to our office?

22. Do you have any other comments or suggestions which might help us to improve our service to you? All comments whether negative or positive are appreciated.

23. Optional Information:
Name:
Address:
Email:
Phone Number:

LVC Patient SurveryExit this survey

1. Default Section

1. Why did you first decide to seek optometric services at our office?

2. Was it easy to get an appointment?

3. When you called our office, how were you treated?

4. Were you warmly greeted when you entered our office?

5. When you arrived at our office, how long after your scheduled appointment did you have to wait before seeing the doctor?

6. What is your general impression of the office?

7. During your last visit, how were you treated by members of our office staff?

8. How knowledgeable and professional was our staff?

9. Which staff member helped you?

10. Which doctor did you see?

11. Please rate me on how "genuinely interested" Dr. Trudell or Dr. Cottrell seemed to be in you as a person?

12. During your exam, did you think the doctor adequately explained to you the procedures, the outcome and your treatment options?

13. Was the vision exam thorough and comprehensive?

14. Did the doctor adequately answer your questions?

15. Did you receive your eyewear or contacts when promised?

16. Are you satisfied with the quality of the optical products that you purchased in our office?

17. What did you think of our selection of frames?

18. At your last visit, was your fee itemized and clearly explained to you?

19. Did you feel our prices are reasonable and fair?

20. Are our office hours convenient?

21. Would you recommend other patients to our office?

22. Do you have any other comments or suggestions which might help us to improve our service to you? All comments whether negative or positive are appreciated.

23. Optional Information:Name:Address:Email:Phone Number:

LVC Patient Survery
Exit this survey

23. Optional Information:
Name:
Address:
Email:
Phone Number: