Patient Survey Name (leave blank for anonymous responses) First Name Last Name Email Survey My experience with this office met expectations: Strongly Disagree Disagree Neutral Agree Strongly Agree It was easy to schedule my appointment: Strongly Disagree Disagree Neutral Agree Strongly Agree The facility/equipment was clean, welcoming, and up to date: Strongly Disagree Disagree Neutral Agree Strongly Agree The staff was professional, kind, and helpful: Strongly Disagree Disagree Neutral Agree Strongly Agree The examination was thorough and efficient: Strongly Disagree Disagree Neutral Agree Strongly Agree I felt well-informed on my vision, eyes, and treatments: Strongly Disagree Disagree Neutral Agree Strongly Agree There was a great selection of eyewear/contact lenses: Strongly Disagree Disagree Neutral Agree Strongly Agree Orders of eyewear/contact lenses were completed in a timely manner: Strongly Disagree Disagree Neutral Agree Strongly Agree My specific vision needs were met: Strongly Disagree Disagree Neutral Agree Strongly Agree The pricing of services and materials is fair and competitive: Strongly Disagree Disagree Neutral Agree Strongly Agree I would recommend this office to a friend: Strongly Disagree Disagree Neutral Agree Strongly Agree Comments/Explanations/Suggestions: Tell us how we can improve, explain your responses, give complements to the staff > How did you hear about our office and services? * Personal recommendation Professional referral Online Search Engine (Google, Bing, etc.) Facebook Other (explain below) Please confirm your age: * How long have you been a patient at our office? * Less than a year 1-5 years 5+ years Thank you for your responses! We will gladly receive any comments on how we can make your eye care experience better. Thank you for trusting us to be a part of your eye care team! We look forward to seeing you again!If you have enjoyed your experience, please also consider leaving us a review on Google and Facebook.