Shenandoah EyeCare Survey

1. Which doctor was your provider at your most recent visit?

Which doctor was your provider at your most recent visit? Michael Gowen, O.D.

Cory Partlow, O.D.

Jennifer Nowak, O.D.

Other, not sure

2. If you phoned this office for emergency treatment within the last year, how easy was it to get the care you needed right away?

If you phoned this office for emergency treatment within the last year, how easy was it to get the care you needed right away? Very Easy

Easy

Not So Easy

Difficult

Very Difficult

3. During visits within the last 12 months, how much time did you have to spend waiting for the doctor after completing the intake form?

During visits within the last 12 months, how much time did you have to spend waiting for the doctor after completing the intake form? 5 minutes or less

10 minutes

20 minutes

30 minutes or more

Comments

4. Did your doctor listen carefully to you and show respect for what you had to say?

Did your doctor listen carefully to you and show respect for what you had to say? Yes completely

Mostly

Somewhat

Not really

Not at all

Comments

5. Using numbers from 1-10 where 1 is the worst and 10 is the best, what number would you rate your experience with your doctor?

Using numbers from 1-10 where 1 is the worst and 10 is the best, what number would you rate your experience with your doctor? 1 2 3 4 5	6 7 8 9 10
Comments

6. Did the front office staff treat you with courtesy and respect?

Did the front office staff treat you with courtesy and respect? Yes, completely

Mostly

Somewhat

Not really

Not at all

Comments

7. Were the doctor's assistance as helpful as you thought they should be?

Were the doctor's assistance as helpful as you thought they should be? Yes, completely

Mostly

Somewhat

Not really

Not at all

Comments

8. Did our optical staff treat you with respect and courtesy and seek to understand your visual needs to find solutions to your concerns?

Did our optical staff treat you with respect and courtesy and seek to understand your visual needs to find solutions to your concerns? Yes completely

Mostly

Somewhat

Not really

Not at all

Comments

9. If you did not purchase eyeglasses here, why did you choose not to?

If you did not purchase eyeglasses here, why did you choose not to? Price

Service

Selection

RX not needed at this time

Other (please specify)

10. Using the numbers 1-10, 10 being the best, what would you rate your overall experience with our practice?

Using the numbers 1-10, 10 being the best, what would you rate your overall experience with our practice? 1 2 3 4 5	6 7 8 9 10
Comments

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1.

1. Which doctor was your provider at your most recent visit?

2. If you phoned this office for emergency treatment within the last year, how easy was it to get the care you needed right away?

3. During visits within the last 12 months, how much time did you have to spend waiting for the doctor after completing the intake form?

4. Did your doctor listen carefully to you and show respect for what you had to say?

5. Using numbers from 1-10 where 1 is the worst and 10 is the best, what number would you rate your experience with your doctor?

6. Did the front office staff treat you with courtesy and respect?

7. Were the doctor's assistance as helpful as you thought they should be?

8. Did our optical staff treat you with respect and courtesy and seek to understand your visual needs to find solutions to your concerns?

9. If you did not purchase eyeglasses here, why did you choose not to?

10. Using the numbers 1-10, 10 being the best, what would you rate your overall experience with our practice?

Shenandoah EyeCare
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