Patient Care Evaluation Form

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= exceeded expectations, 1= very dissatisfied)

OTHER INFORMATION

– You may elaborate on any information below, and/or in the office