Evaluation Form Close Window

Please take a few seconds to complete this evaluation. We greatly appreciate
your feedback and will use this information to better serve your eye care needs
      (Name Optional)  
  Yes   No  N/A  
    Was our staff courteous and helpful?        

    Were you seen in a timely manner?        

    Was your examination thorough?        

    Were you satisfied with your visual condition & treatment options explanations?        

    Did our contact lens/eyeglasses service & quality meet your expectations?        

    Will you refer others to our office for their eye care?        
    Please rate your overall satisfaction with our office.   5   4   3   2   1
      (5= exceeded expectations,  1= very dissatisfied)          

OTHER INFORMATION - You may elaborate on any information below, and/or in the office