Patient Satisfaction Survey Communication prior to appointment:GreatGoodFairPoorN/AAppointment availability:GreatGoodFairPoorN/AWaiting room time:GreatGoodFairPoorN/AFees:GreatGoodFairPoorN/AQuality of care from staff:GreatGoodFairPoorN/AQuality of care from doctor:GreatGoodFairPoorN/AConcerns or questions answered:GreatGoodFairPoorN/AOverall quality of care:GreatGoodFairPoorN/APreferred day for appointmentsMondayTuesdayWednesdayThursdayFridayNo preferencePreferred time for appointments:7AM-9AM9AM-5PMNo PreferenceDo you plan on returning for your next comprehensive examination?YesNoFor no, please tell us why not:Would you schedule appointments online?:YesNoSatisfaction with eyeglasses:GreatGoodFairPoorN/ASatisfaction with contact lenses:GreatGoodFairPoorN/ARange of eyeglasses selection:GoodToo fewToo manyToo many of the same typeIdentification (Optional)Why did you choose us for your eye health care?Name First Additional Comments
