Question Title

* 1. Please indicate which location you visited.

Question Title

* 2. What was the key reason(s) you chose our practice for your eye care?

Question Title

* 3. How were you given registration paperwork prior to your visit?

Question Title

* 4. Please select the most appropriate answer for each question.

  Poor Unsatisfactory Satisfactory Good Excellent N/A
Length of waiting (from appointment time) in front reception area
Overall satisfaction with our practice
Availability of desired time and location for appointment
Courtesy of our staff while checking in and out
Your ability to reach our front office by phone
Length of waiting time in the back clinical area
Overall satisfaction with your physician
Courtesy and helpfulness regarding insurance/payments
Courtesy and knowledge of our medical assistants
Physician's courtesy and willingness to answer questions

Question Title

* 5. Staff are treated fairly by the physician when mistakes are made.

Question Title

* 6. Do you use our online patient portal to access your health and account information?

Question Title

* 7. How likely is it that you would recommend this company to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

Question Title

* 8. Do you have any other comments, questions, or concerns?

0 of 8 answered
 

T