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* 1. Please indicate which location you visited.

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

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

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

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

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

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

NOT AT ALL LIKELY
EXTREMELY LIKELY

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

0 of 8 answered
 

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