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My Care Optical's Patient Satisfaction Survey
1.
How satisfied were you with the professionalism and friendliness of our staff?
Very satisfied
Satisfied
Neutral
Dissatisfied
2.
How clearly did the optometrist explain your eye health, any vision issues, and treatment options?
Extremely clear
Somewhat clear
Neutral
Not very clear
3.
How satisfied were you with the thoroughness of the eye examination?
Very satisfied
Satisfied
Neutral
Dissatisfied
Other (please specify)
*
4.
If you were prescribed glasses or contact lenses, how satisfied were you with the selection and fitting process?
(Required.)
Very satisfied
Satisfied
Neutral
Dissatisfied
Not applicable
5.
How likely are you to recommend our optometry practice to friends or family?
Extremely likely
Somewhat likely
Neutral
Somewhat unlikely
Extremely unlikely
Other (please specify)
6.
How satisfied are you with your overall experience during today's visit?
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
Other (please specify)
7.
Did the optometrist address all of your concerns and questions adequately?
Yes, all of them
Yes, most of them
Some of them
No, none of them
Other (please specify)
8.
How comfortable were you during the examination process?
Very comfortable
Comfortable
Neutral
Uncomfortable
Very uncomfortable
9.
Were you provided with enough information about any prescribed medications or vision correction options?
Yes, more than enough
Yes, sufficient
Not really
No, not at all
*
10.
Do you have any additional comments, feedback or suggestions for improving our services?
(Required.)