Family Vision Centers Patient Satisfaction Survey

Thank you for choosing Family Vision Centers for your vision care. Your satisfaction with our service is important to us. In an effort to best serve our patients we ask that you please complete this short, anonymous survey.

* Indicates a required field

Please fill out all the required fields before submitting the survey.

How can we improve? Please enter any comments or suggestions below:

What is your name? (Optional, but it helps us provide better service)

Which doctor did you see? (If you saw the doctor)

1. Convenience of our office hours *	Excellent	Very Good	Good	Fair	Poor
2. Ease of making your appointment *	Excellent	Very Good	Good	Fair	Poor
3. Promptness with which you were seen by the doctor *	Excellent	Very Good	Good	Fair	Poor
4. Thoroughness of care you received and Doctor's explanations*	Excellent	Very Good	Good	Fair	Poor
5. Doctor's friendliness and courtesy *	Excellent	Very Good	Good	Fair	Poor
6. Staff's friendliness and courtesy *	Excellent	Very Good	Good	Fair	Poor
7. Help with understanding your insurance coverage (if applicable)	Excellent	Very Good	Good	Fair	Poor
8. Selection of eyeglass frames	Excellent	Very Good	Good	Fair	Poor
9. Knowledge/assistance of optical staff	Excellent	Very Good	Good	Fair	Poor
10. Comfort and cleanliness of office *	Excellent	Very Good	Good	Fair	Poor
11. Overall satisfaction with your visit *	Excellent	Very Good	Good	Fair	Poor
12. Will you be returning to see us? *	Yes	No	Uncertain
13. Would you recommend us to others? *	Yes	No	Uncertain

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Family Vision Centers Patient Satisfaction Survey