Patient Survey

Please answer a few questions regarding the appointment you had at one of our offices.

Select your Doctor:

The courtesy and helpfulness of the office staff:

Length of time spent waiting at the office:

Time spent with the optometrist you saw:

Personal manner (courtesy, respect) of the optometrist you saw:

Frame selection in optical dispensary:

Knowledge of optician helping you with frame and lens selection:

The visit overall:

Do you have any additional comments regarding your vision services?

Name (optional)?

Would you like to be contacted regarding your visit?
Yes No