Patient Feedback

Feedback Survey

Email Address:
1. Was our staff courteous and helpful? Yes No
2. Were you seen in a timely manner? Yes No
3. Was your examination thorough? Yes No
4. Were you satisfied with the explanation of your visual conditions and treatment options? Yes No N/A
5. If fit with contact lenses or glasses, did the service and quality meet your expectations? Yes No
6. Would you refer a friend to our office for eye care? Yes No
7. How would you rate your overall satisfaction with our office?
8. May we contact you to discuss any outstanding questions or concerns? Yes No
9. If you answered "Yes" to the above question, what is the best way to contact you?
10. Other comments and/or name (optional):
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Emergency care is available by calling 512-587-7232

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