Office Survey

PATIENT SATISFACTION SURVEY

We want to give you the best possible optometric care. To do that, we need your feedback. Please let us know what you think we're doing right, and how we can improve, by filling out the following patient survey. All of your responses will be kept strictly confidential and your name is not required. So please use this opportunity to respond freely. Thank you for helping us serve you better.

1. Why did you first decide to seek optometric services in this office?
Referral by a relative
Referral by another patient
Near home or business
Insurance program
Benefit plan through your employment
Yellow page ad
Other:

2. Was it easy to get a appointment?
Yes
No Please Explain:

3. When you called our office how were you treated?
Royally
Courteously
Coldly
Like a poor relative
Comments:

4. Were you warmly greeted when you entered our office?
Yes
No Please explain:

5. When you arrived at our office, how long after your scheduled appointment did you have to wait before seeing a doctor?
Less than 10 minutes
11 to 20 minutes
More than 20 minutes
Comments:

6 What is your general impression of the office itself?
Beautiful
Nice
Typical
Shabby
Comments:

7. During your last visit, how were you treated by members of our office staff?
Like an old friend
Pleasantly
Indifferently
Coldly
Comments:

8. How knowledgeable and professional was our staff?
Well trained and helpful
Somewhat knowledgeable
Not helpful
Comments:

9. Which staff member helped you?

10. Which doctor did you see?
Dr. Trudell
Dr. Baker

11. Please rate me on how "genuinely interested" Dr. Trudell or Dr. Baker seemed to be in you as a person?
Very interested and concerned
Somewhat interested and concerned
Did not seem to have enough time for me
Comments:

12. During your vision exam, did you think the doctor adequately explained to you the procedures, the outcome, and your treatment options?
Yes
No
If No, how could the doctor improve?

13. Was the vision exam thorough and comprehensive?
Yes
No
Comments:

14. Did the doctor adequately answer your questions?
Yes
No (If no, how could the doctor improve?

15. Did you receive your eyewear or contacts when promised?
Yes
No Please explain:

16. Are you satisfied with the quality of the optical products that you purchased in our office?
Yes
No Please explain:

17. What did you think of our selection of frames?
Great selection of frames
Adequate selection
Could be better Please explain:

18. At your last visit, was your fee itemized and clearly explained to you?
Yes
No If No how could we improve:

19. Do you feel that our prices are reasonable and fair?
Yes
No Please explain:

20. Are our office hours convenient?
Yes
No Please explain:

21. Would you recommend other patients to our office?
Yes
No Please explain:

22. Do you have any other comments or suggestions which might help us to improve our service to you? All comments whether positive or negative are appreciated.

OPTIONAL:

Name:
Email Address:
Address:
City:
State: Zip:
Phone:

If you have any comments that you would like to discuss with us "personally", please call us at 303-651-6700.

THANK YOU ONCE AGAIN!