How was your eye exam?

Hi 👋 A few questions about your visit to [clinic name], from the exam itself to how long you waited. Say what did not work, that is what we can fix. Under 2 minutes.

2. What did you come in for?

Select one answer

  • Routine eye exam
  • Prescription update
  • Contact lens fitting
  • Glasses purchase
  • Eye health concern or treatment

3. How would you rate the exam?

Select one answer in each row

  • Poor
  • OK
  • Great

Thorough

  • Poor
  • OK
  • Great

Explained clearly

  • Poor
  • OK
  • Great

Took time for me

  • Poor
  • OK
  • Great

Professional

  • Poor
  • OK
  • Great

4. How was the rest of the team?

Select one answer

  • Excellent
  • Good
  • Fair
  • Poor
  • Very poor

5. How would you rate the clinic?

Select one answer in each row

  • Poor
  • OK
  • Great

Cleanliness

  • Poor
  • OK
  • Great

Waiting time

  • Poor
  • OK
  • Great

Easy to get to

  • Poor
  • OK
  • Great

6. How did the advice about glasses or lenses feel?

Select one answer

  • Helpful, no pressure
  • Slightly pushy
  • Too pushy
  • We did not discuss it

7. How likely are you to recommend [clinic name]?

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Not at all likely

Extremely likely

8. What would you change?

500

Powered by Survio
Use template

Survey Templates Business Specific

Eye Care Patient Satisfaction

Who it's for

Opticians and eye clinics. Send it a few days after the appointment, once the new glasses have been worn for a while.

Who answers

Your patient, on a phone, in two minutes. No health questions.

Use template

What you'll see

  • The exam and the shop rated separately, because people judge them separately
  • Whether the advice about frames and lenses felt like help or like a sales push
  • How the rest of the team came across, not just the optometrist
  • How many would recommend you, and what the rest would change

How to get good answers

  • Wait three or four days. On the day of the fitting everyone is polite; once the glasses have been worn to work, the answers get specific.
  • Ask about the advice and the exam in the same survey. An optician is half healthcare and half shop, and one good half hides a bad one.
  • Send it to everyone who had an exam, including people who walked out without buying. They are the ones who felt the pressure.
  • Keep it anonymous and say so. Nobody writes "I felt pushed" under their own name to a person they will see again next year.

All templates

Template categories

Trustpilot rating

Rated excellent on

Survio is a survey software for everyone.

Survey templates make your start quick and smooth. Collect any feedback effortlessly.

Create a questionnaire in less than one minute

Create a questionnaire in less than one minute

Collect survey responses on multiple channels

Collect survey responses on multiple channels

Analyze survey results with a single click

Analyze survey results with a single click

What people say about us

Marketing manager, HR specialist and sales director sharing their experience with Survio.

Survey creation is straightforward and simple. Easy to navigate as a survey creator as well as a survey respondent. Quick to make unique surveys tailored to your and your company's purpose.

Linda W. Marketing manager

I've been able to design multiple surveys in just a few minutes. I'm particularly excited about the data collection, analysis, reporting & exporting capabilities, which are critical to my success as an HR.

Liam J. HR specialist

I highly recommend Survio as it is user-friendly and professional. It is definitely worth updating the free account to get more advanced features and make it an integral part of your workflow.

Edward G. Sales director

It’s not just a template. You’ll get the entire survey platform to collect desired data and understand them.

Create your survey now

Enter Survio

Login

Forgot password?

Digicert

Start surveying now!

  • Build a survey Easy-to-use survey editor, 100+ ready-made survey templates
  • Collect responses Mobile friendly, omnichannel collection, identity tracking
  • Analyze results Fast and comprehensive analytics, one-click reports
  • Engage with Survio PRO User management, custom dashboards, integrations, API
  • GDPR
  • SSO
  • ISO 27001:2022

Get in touch with Sales team

Do you have a request for Demo, Custom quote or any other commercial related query? Let us know and our team will get back to you promptly.

This form serves for business related topics to our Sales team.

Survio.com is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you:
You can unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Privacy Policy.
By clicking submit below, you consent to allow Survio.com to store and process the personal information submitted above to provide you the content requested.