Communication prior to appointment:
- Great
- Good
- Fair
- Poor
- N/A

Appointment availability:
- Great
- Good
- Fair
- Poor
- N/A

Waiting room time:
- Great
- Good
- Fair
- Poor
- N/A

Quality of care from staff:
- Great
- Good
- Fair
- Poor
- N/A

Quality of care from doctor:
- Great
- Good
- Fair
- Poor
- N/A

Concerns or questions answered:
- Great
- Good
- Fair
- Poor
- N/A

Overall quality of care:
- Great
- Good
- Fair
- Poor
- N/A

Do you plan on returning for your next comprehensive examination?
- Yes
- No

For no, please tell us why not


Satisfaction with eyeglasses:
- Great
- Good
- Fair
- Poor
- N/A

Satisfaction with contact lenses:
- Great
- Good
- Fair
- Poor
- N/A

Why did you choose us for your eye health care?


Your name (optional)