Patient Eye Care Quality Survey
10:10/ 10:30AM |
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| 1. What was your primary reason for coming to
Eagle Eye Associates? |
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A. Advertisement |
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B. Team Sponsor |
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C. Yellow Pages |
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D. Race Sponsor |
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E. Other |
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| 2. Do you feel we were attentive to your eye
care needs: (Choose all that apply)? |
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A. At the front desk |
C. When choosing your Glasses or Contacts |
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B. During the exam |
D. When picking up your Glasses or Contacts |
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| 3. Were you able to make your appointment at
a convenient time? |
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A. Very convenient |
C. Inconvenient |
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B. Somewhat convenient |
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4. Do you feel the staff clearly understood your
concerns:
(Choose all that apply) |
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A. At the front desk |
C. In the exam room |
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B. During the Pre-Exam testing |
D. When ordering Glasses or Contacts |
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| 5. Did our staff keep their promises with regards
to: (Choose all that apply) |
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A. On time for scheduled appointment |
C. Glasses/Contacts ready when promised |
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B. Price quoted was price paid |
D. Visual expectations met with Contacts/Glasses |
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| 6. Did the office: (Choose all that apply) |
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A. Confirm your appointment |
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Please check box if appointment was scheduled within 2 days of your
visit. |
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B. Notify you that your Glasses/Contacts were ready on or before promised
date |
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C. Make a follow up call after picking up your Glasses/Contacts |
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| 7. Was the staff and your experience: |
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A. Friendly and Inviting |
C. Unfriendly |
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B. Indifferent |
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| 8. Were you treated with respect: (Choose all
that apply): |
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A. By the front desk |
C. By the doctor |
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B. By the technician performing pre-exam testing |
D. By the opticians |
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| 9. Were your eyewear options presented? |
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A. In a professional manner |
C. In an unprofessional manner |
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B. In a less than professional manner |
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| 10. Was your order processed correctly the first
time? |
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A. Yes |
B. No |
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11. Were we helpful in obtaining information
about your
insurance and explaining coverage? |
| A. Yes |
B. No |
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12. How would you rate the overall value of your
contact
lens or eyeglass purchase: |
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A. Better than expected |
C. Less than expected |
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B. Met Expectations |
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13. Will you return to Eagle Eye Associates in
the future for
your eye care needs? |
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A. Yes |
B. No |
| If no, please explain: |
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| 14. Will you recommend us to a friend? |
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A. Yes |
B. No |
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| 15. In striving to be the best provider for your
eye care needs, we ask that you share any additional thoughts with
us below: |
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| Email (optional) |
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Only Click "Submit Survey" if you are over Eighteen (18) Years
Old.
We
do not collect information on children.
See
Privacy Statement
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