Look + See Eye Clinic - Customer Satisfaction Survey

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* 1. Was our staff courteous and helpful?

Yes

No

Other (please specify)

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* 2. Did our doctor address the reasons for your visit?

Yes

No

I did not have an exam.

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* 3. Which doctor did you see?

Dr. Sarah Jerome, Optometrist

Dr. Andrea VanMeter, Optometrist

I did not have an eye exam.

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* 4. Were you satisfied with the explanation of your vision conditions and treatment options?

Yes

No

I did not have an eye exam.

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* 5. Were you satisfied with the selection of eyewear?

Yes

No

Other (please specify)

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* 6. If fit with glasses, did the service and quality meet your expectations?

Yes

No

I was not fit with glasses.

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* 7. Would you refer a family member or friend to our office for eye care or eyeglasses?

Yes

No

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* 8. Why or why not?

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* 9. If there was one thing you would suggest we could do to improve your experience at Look + See Eye Care, what would it be?

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* 10. Thank you for completing our survey! Enter to win a $100 gift certificate by completing the information below.

Name: *

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address: *