Reason for Visit
Examination
Office Visit
Eyewear Pickup
Problem with Prescription
Your Appointment
Agree
Somewhat Agree
Disagree
N/A
It was easy to make an appointment.
I found the available appointment times to be convenient.
I did not have to wait long to be seen.
I was warmly greeted when I arrived for my appointment.
Your Visit
During your workup, before seeing the doctor, was the technician friendly and courteous?
Yes
No
Did the technician explain the reasons the tests were being done?
Who was your tech?
Was the doctor friendly and courteous?
Did the doctor explain the reason the tests were being done?
Did the doctor adequately address your concerns and questions?
Who was your doctor?
Dr. Friedberg
Associate Doctor
I Don't Know
The Optical Botique
Was your eyewear consultant friendly and courteous?
Were you offered a variety of options when choosing:
Frames:
Lenses:
Who was your eyewear consultant?
Check Out
Do you feel the check out process was completed in a timely manner?
Was the person who checked you out friendly and courtesous?
Were your charges adequately explained to you?
Were any of your charges billed to insurance?
If yes, which insurance?
General Impressions
The office was clean and orderly.
The temperature in the office was overall comfortable.
The fees charged were fair and reasonable.
My overall impressions of my visit were:
Very positive
Somewhat positive
Somewhat negative
Very negative
The likelihood that I would refer someone to this office is:
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
Please feel free to add any other comments / suggestions that you may have.
Your name (Optional):
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