Please indicate your satifcation with ECS

Eye Center South Refractive Surgery Patient Satisfaction Survey

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Thank you for trusting Eye Center South for your recent refractive eye surgery. To help us improve our service ,we would like to invite you to provide us your comments and suggestions about your procedure and we thank you in advance for your consideration.

We not only appreciate your participation, but we also value your input. Thank you for letting us be of service to you.

Please indicate your satisfaction with Eye Center South

Care Before Surgery:

	Extremely Satisfied	Satified	Neither Satified or Dissatisfied	Dissatisfied	Extremely Dissatified
Was the information and video on the procedure helpful and understandable?	*Care Before Surgery: Was the information and video on the procedure helpful and understandable? Extremely Satisfied	Was the information and video on the procedure helpful and understandable? Satified	Was the information and video on the procedure helpful and understandable? Neither Satified or Dissatisfied	Was the information and video on the procedure helpful and understandable? Dissatisfied	Was the information and video on the procedure helpful and understandable? Extremely Dissatified
Were instructions before surgery clear and useful?	Were instructions before surgery clear and useful? Extremely Satisfied	Were instructions before surgery clear and useful? Satified	Were instructions before surgery clear and useful? Neither Satified or Dissatisfied	Were instructions before surgery clear and useful? Dissatisfied	Were instructions before surgery clear and useful? Extremely Dissatified
Were you given adequate financial information and options?	Were you given adequate financial information and options? Extremely Satisfied	Were you given adequate financial information and options? Satified	Were you given adequate financial information and options? Neither Satified or Dissatisfied	Were you given adequate financial information and options? Dissatisfied	Were you given adequate financial information and options? Extremely Dissatified
Was our clincal staff helpful and knowledgeable regarding your procedure and evaluation testing?	Was our clincal staff helpful and knowledgeable regarding your procedure and evaluation testing? Extremely Satisfied	Was our clincal staff helpful and knowledgeable regarding your procedure and evaluation testing? Satified	Was our clincal staff helpful and knowledgeable regarding your procedure and evaluation testing? Neither Satified or Dissatisfied	Was our clincal staff helpful and knowledgeable regarding your procedure and evaluation testing? Dissatisfied	Was our clincal staff helpful and knowledgeable regarding your procedure and evaluation testing? Extremely Dissatified

Surgery Experience:

	Extremely Satisfied	Satified	Neither Satified or Dissatisfied	Dissatisfied	Extremely Dissatified
Were you comfortable and well treated during the procedure?	*Surgery Experience: Were you comfortable and well treated during the procedure? Extremely Satisfied	Were you comfortable and well treated during the procedure? Satified	Were you comfortable and well treated during the procedure? Neither Satified or Dissatisfied	Were you comfortable and well treated during the procedure? Dissatisfied	Were you comfortable and well treated during the procedure? Extremely Dissatified
Was the surgical staff helpful and professional?	Was the surgical staff helpful and professional? Extremely Satisfied	Was the surgical staff helpful and professional? Satified	Was the surgical staff helpful and professional? Neither Satified or Dissatisfied	Was the surgical staff helpful and professional? Dissatisfied	Was the surgical staff helpful and professional? Extremely Dissatified

Care after Surgery:

	Extremely Satisfied	Satified	Neither Satified or Dissatisfied	Dissatisfied	Extremely Dissatified
Were you satisfied with your care after the procedure?	*Care after Surgery: Were you satisfied with your care after the procedure? Extremely Satisfied	Were you satisfied with your care after the procedure? Satified	Were you satisfied with your care after the procedure? Neither Satified or Dissatisfied	Were you satisfied with your care after the procedure? Dissatisfied	Were you satisfied with your care after the procedure? Extremely Dissatified
Were the instructions after surgery clear and understandable?	Were the instructions after surgery clear and understandable? Extremely Satisfied	Were the instructions after surgery clear and understandable? Satified	Were the instructions after surgery clear and understandable? Neither Satified or Dissatisfied	Were the instructions after surgery clear and understandable? Dissatisfied	Were the instructions after surgery clear and understandable? Extremely Dissatified
Usefulness/value of postoperative supplies kit	Usefulness/value of postoperative supplies kit Extremely Satisfied	Usefulness/value of postoperative supplies kit Satified	Usefulness/value of postoperative supplies kit Neither Satified or Dissatisfied	Usefulness/value of postoperative supplies kit Dissatisfied	Usefulness/value of postoperative supplies kit Extremely Dissatified

If you attended a Refractive Event/Seminar, how would you rate the program on:

	Extremely Satisfied	Satified	Neither Satified or Dissatisfied	Dissatisfied	Extremely Dissatified
The information received?	*If you attended a Refractive Event/Seminar, how would you rate the program on: The information received? Extremely Satisfied	The information received? Satified	The information received? Neither Satified or Dissatisfied	The information received? Dissatisfied	The information received? Extremely Dissatified
The helpfulness of staff?	The helpfulness of staff? Extremely Satisfied	The helpfulness of staff? Satified	The helpfulness of staff? Neither Satified or Dissatisfied	The helpfulness of staff? Dissatisfied	The helpfulness of staff? Extremely Dissatified
Your questions and concerns being answered?	Your questions and concerns being answered? Extremely Satisfied	Your questions and concerns being answered? Satified	Your questions and concerns being answered? Neither Satified or Dissatisfied	Your questions and concerns being answered? Dissatisfied	Your questions and concerns being answered? Extremely Dissatified
The facility and format in which the seminar was conducted?	The facility and format in which the seminar was conducted? Extremely Satisfied	The facility and format in which the seminar was conducted? Satified	The facility and format in which the seminar was conducted? Neither Satified or Dissatisfied	The facility and format in which the seminar was conducted? Dissatisfied	The facility and format in which the seminar was conducted? Extremely Dissatified
Overall helpfulness on you deciding on surgery	Overall helpfulness on you deciding on surgery Extremely Satisfied	Overall helpfulness on you deciding on surgery Satified	Overall helpfulness on you deciding on surgery Neither Satified or Dissatisfied	Overall helpfulness on you deciding on surgery Dissatisfied	Overall helpfulness on you deciding on surgery Extremely Dissatified

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Based on your experience, would you recommend Eye Center South to friends and acquaintances?

	Definitely Would	Probably Would	Neither Would Nor Wouldn’t	Probably Wouldn’t	Definitely Wouldn’t
Would you recommend Eye Center South to friends and acquaintances?	*Based on your experience, would you recommend Eye Center South to friends and acquaintances? Would you recommend Eye Center South to friends and acquaintances? Definitely Would	Would you recommend Eye Center South to friends and acquaintances? Probably Would	Would you recommend Eye Center South to friends and acquaintances? Neither Would Nor Wouldn’t	Would you recommend Eye Center South to friends and acquaintances? Probably Wouldn’t	Would you recommend Eye Center South to friends and acquaintances? Definitely Wouldn’t
Would you recommend a LASER procedure at Eye Center South to your friends and family?	Would you recommend a LASER procedure at Eye Center South to your friends and family? Definitely Would	Would you recommend a LASER procedure at Eye Center South to your friends and family? Probably Would	Would you recommend a LASER procedure at Eye Center South to your friends and family? Neither Would Nor Wouldn’t	Would you recommend a LASER procedure at Eye Center South to your friends and family? Probably Wouldn’t	Would you recommend a LASER procedure at Eye Center South to your friends and family? Definitely Wouldn’t

Are you satisfied with the results you received after your procedure?

Are you satisfied with the results you received after your procedure? Yes

Additional Comments that would help us IMPROVE our services:

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