Optical studios / eye care patient satisfaction questionnaire template

Hello,

Please take a few minutes of your time to fill in the following survey.

1. Where did you first hear about our optical services?

  • Advertising
  • Internet
  • Recomendation

2. How did you book your professional eye appointment?

  • Over the phone
  • In person
  • Via email
  • Using our website

3. Did you have any problems booking your appointment?

  • No

4. How would you rate your examination overall?

  • I strongly agree
  • I agree
  • I am unsure
  • I disagree
  • I strongly disagree

It was a nice experience

  • I strongly agree
  • I agree
  • I am unsure
  • I disagree
  • I strongly disagree

The examination was carried out quickly

  • I strongly agree
  • I agree
  • I am unsure
  • I disagree
  • I strongly disagree

The Optician or specialist operated professionaly

  • I strongly agree
  • I agree
  • I am unsure
  • I disagree
  • I strongly disagree

The Optician accommodated me and adapted to my needs

  • I strongly agree
  • I agree
  • I am unsure
  • I disagree
  • I strongly disagree

The Optician provided me with all the necessary information

  • I strongly agree
  • I agree
  • I am unsure
  • I disagree
  • I strongly disagree

5. Do you prefer to wear Contact Lenses or Spectacles?

  • Contact Lenses
  • Spectacles

6. How would you rate your overall experience with us?

Please rate the following points on a scale from 1 to 5, 1 - Excellent, 5 - Very poor

  • 1
  • 2
  • 3
  • 4
  • 5

The facilities, equipment and comfort during your visit

  • 1
  • 2
  • 3
  • 4
  • 5

Your experience with our Staff

  • 1
  • 2
  • 3
  • 4
  • 5

Your experience in the examination room

  • 1
  • 2
  • 3
  • 4
  • 5

The range of Spectacles and contact lenses we offer

  • 1
  • 2
  • 3
  • 4
  • 5

The range of acessories available

  • 1
  • 2
  • 3
  • 4
  • 5

How quickly your new eyeware was produced

  • 1
  • 2
  • 3
  • 4
  • 5

How do you rate our pricing plan

  • 1
  • 2
  • 3
  • 4
  • 5

Your experience with the optical consultant

  • 1
  • 2
  • 3
  • 4
  • 5

7. Would you recommend us to a friend or collegue?

  • Yes

8. Please confirm your gender:

  • Male
  • Female

9. Please confirm your age:

10. Please tell us how you would like us to improve:

500

Use template — it’s free

Optical Health / Eye Care patient satisfaction survey

Popularity 138 ×

What is the level of optical services in your optical studio? Be a leader in the field with the help of this questionnaire template for the evaluation of optics stores.

Use template — it’s free

The survey sample is ideal for

  • optics stores owners and operators,
  • optical studio managers.

Adapt your services to existing customers so that they do not need to consider changing the optician. Take care of their satisfaction with the perfect service, material equipment and behavior of your staff. Don’t be afraid to conduct regular studio evaluation surveys to show you how effective this effort is and whether some visions and plans should not be reconsidered here and there. Make decisions based on relevant data and feedback from your customers.

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