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Satisfaction/Feedback Form

Please take a few moments and let us know what you thought of your last visit…

We are now implementing a new Patient Appreciation Program. If you would like to participate and receive a $5 credit, ensure that you add your name to the survey and then click on the linked image that appears once the form is submitted.

  • Provider

  • Service Ratings

  • GreatGoodFairPoorN/A
    Communication Prior to Appointment
    Appointment Availability
    Waiting Room Time
    Quality of Care from Staff
    Quality of Care from Doctor
    Concerns or Questions Answered
    Overall Quality of Care
  • Scheduling

  • Products

  • GreatGoodFairPoorN/A
    Satisfaction with Eyeglasses
    Satisfaction with Contact Lenses
  • Identification