Satisfaction/Feedback Survey

Please let us know how your last visit went.

Location

Doctor

Service Ratings

Communication prior to appointment

Appointment availability

Waiting room time

Fees

Quality of care from staff

Quality of care from doctor

Concerns or questions answered

Overall quality of care

Scheduling

Preferred day for appointments

Preferred time for appointments

Do you plan on returning for your next comprehensive examination?

Yes
No

Please tell us why not

Would you schedule appointments online?

Yes
No

Please tell us why not

Products

Satisfaction with eyeglasses

Satisfaction with contact lenses

Range of eyeglasses selection

Identification - This section is optional.

Why did you choose us for your eye health care?

Your Name (Optional)

First Last

Additional comments

Phone

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Keep up to Date

Satisfaction/Feedback Survey

Service Ratings

Scheduling

Products

Identification - This section is optional.

Our Locations

Walled Lake

South Lyon

South Lyon

Walled Lake

Be Our Friend Keep up to Date

Service Ratings

Scheduling

Products

Identification - This section is optional.

Our Locations

Walled Lake

South Lyon

Be Our Friend
Keep up to Date