Patient Satisfaction Survey

1. How professional and courteous was our staff on the phone?
(5 being the best----1 being the worst)

How professional and courteous was our staff on the phone? (5 being the best----1 being the worst) 1

2

3

4

5

Other (please specify)

2. During your office visit, how well did we listen to your specific needs?
(5 being the best----1 being the worst)

During your office visit, how well did we listen to your specific needs? (5 being the best----1 being the worst) 1

2

3

4

5

Other (please specify)

3. How well were you educated on the vision tests and exams you received?
(5 being the best----1 being the worst)

How well were you educated on the vision tests and exams you received? (5 being the best----1 being the worst) 1

2

3

4

5

Other (please specify)

4. How would you rate the value of the services and products you received?
(5 being the best----1 being the worst)

How would you rate the value of the services and products you received? (5 being the best----1 being the worst) 1

2

3

4

5

Other (please specify)

5. How courteous and professional was our clincial staff during the exam portion of your visit?
(5 being the best----1 being the worst)

How courteous and professional was our clincial staff during the exam portion of your visit? (5 being the best----1 being the worst) 1

2

3

4

5

Other (please specify)

6. Would you recommend our practice to your family and friends?

Would you recommend our practice to your family and friends? Yes

No

7. Overall, do you believe the time you spent in our office was (check one):

Overall, do you believe the time you spent in our office was (check one): Comprehensive, just what I thought.

Too long, could have taken less time.

Too short, not enough time taken with my specific needs.

8. If you chose not to purchase eyewear from Watauga Eye Center, PA, which of the following best describes the reason why:

If you chose not to purchase eyewear from Watauga Eye Center, PA, which of the following best describes the reason why: Service

Selection

Price

Didn't want new glasses this year.

Other

Other (please specify)

9. Are there any employees that you would like to recognize for their service?

Are there any employees that you would like to recognize for their service?

10. To be eligible for a $50 prize, please provide the following information. Elibility requirements: 18 years of age, office visit within 30 days of survey submission,limit of one per 12 mo period, limit of one per location per 12 mo period.

To be eligible for a $50 prize, please provide the following information. Elibility requirements: 18 years of age, office visit within 30 days of survey submission,limit of one per 12 mo period, limit of one per location per 12 mo period. Name:
City/Town:
State:
Email Address:
Phone Number:

Patient Satisfaction Survey
Exit this survey

1. Default Section

1. How professional and courteous was our staff on the phone?
(5 being the best----1 being the worst)

2. During your office visit, how well did we listen to your specific needs?
(5 being the best----1 being the worst)

3. How well were you educated on the vision tests and exams you received?
(5 being the best----1 being the worst)

4. How would you rate the value of the services and products you received?
(5 being the best----1 being the worst)

5. How courteous and professional was our clincial staff during the exam portion of your visit?
(5 being the best----1 being the worst)

6. Would you recommend our practice to your family and friends?

7. Overall, do you believe the time you spent in our office was (check one):

8. If you chose not to purchase eyewear from Watauga Eye Center, PA, which of the following best describes the reason why:

9. Are there any employees that you would like to recognize for their service?

10. To be eligible for a $50 prize, please provide the following information. Elibility requirements: 18 years of age, office visit within 30 days of survey submission,limit of one per 12 mo period, limit of one per location per 12 mo period.

Patient Satisfaction SurveyExit this survey

1. Default Section

1. How professional and courteous was our staff on the phone?(5 being the best----1 being the worst)

2. During your office visit, how well did we listen to your specific needs?(5 being the best----1 being the worst)

3. How well were you educated on the vision tests and exams you received?(5 being the best----1 being the worst)

4. How would you rate the value of the services and products you received?(5 being the best----1 being the worst)

5. How courteous and professional was our clincial staff during the exam portion of your visit?(5 being the best----1 being the worst)

6. Would you recommend our practice to your family and friends?

7. Overall, do you believe the time you spent in our office was (check one):

8. If you chose not to purchase eyewear from Watauga Eye Center, PA, which of the following best describes the reason why:

9. Are there any employees that you would like to recognize for their service?

10. To be eligible for a $50 prize, please provide the following information. Elibility requirements: 18 years of age, office visit within 30 days of survey submission,limit of one per 12 mo period, limit of one per location per 12 mo period.

Patient Satisfaction Survey
Exit this survey

1. How professional and courteous was our staff on the phone?
(5 being the best----1 being the worst)

2. During your office visit, how well did we listen to your specific needs?
(5 being the best----1 being the worst)

3. How well were you educated on the vision tests and exams you received?
(5 being the best----1 being the worst)

4. How would you rate the value of the services and products you received?
(5 being the best----1 being the worst)

5. How courteous and professional was our clincial staff during the exam portion of your visit?
(5 being the best----1 being the worst)