Optical Health / Eye Care patient satisfaction survey

Optical Health / Eye Care patient satisfaction survey

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Optical Health / Eye Care patient satisfaction survey

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:

500

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

500

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