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Eye Gallery Patient Satisfaction Survey
Hello,
Please take a few minutes of your time to fill in the following survey.
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Eye Gallery Customer Survey
1
Where did you first hear about our optometry services?
Advertising
Facebook/Instagram
Recommendation
Other (Please specify)
2
How did you book your professional eye appointment?
Over a phone call
In person
Via Whatsapp
Via Facebook
Other (Please specify)
3
Did you have any problems booking your appointment?
No
Yes (Please specify)
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
The examination was carried out quickly
The optometrist operated professionaly
The optometrist accommodated me and adapted to my needs
The optometrist provided me with all the necessary information
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
Your experience with our staff
Your experience in the examination room
The range of spectacles and contact lenses we offer
The range of accessories available
How quickly your new eyewear was produced
How do you rate our pricing plan
Your experience with the optometrist
7
Would you recommend us to a friend or colleague?
Yes
No (Please specify)
8
Please confirm your gender:
Male
Female
9
Please confirm your age:
10
Please tell us how you would like us to improve:
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