Satisfaction Survey

Why did you choose Cranston Market Optometry for your eye health care? *

Service Rating

Communication prior to appointment *

Appointment availability *

Waiting room time *

Fees *

Concerns or questions answered *

Overall quality of care *

Scheduling

Preferred day for appointments *

Preferred time for appointments *

Do you plan on returning for your next comprehensive examination? *

Yes No

Please tell us why not.

Eye Examination

Please rate your experience of your eye exam...

Thorough care *

Professionalism *

Explanation of results *

Products

Range of eyeglasses selection *

Range of sunglasses selection *

Did you purchase your glasses and/or sunglasses at Cranston Market Optometry? *

Yes No I do not require glasses

Knowledge of product *

Helpfulness of staff *

How would you rate the value of services and products you received? *

How well did we follow up with you? *

If you purchased eyewear somewhere other than Cranston Market Optometry, what was the reason why you chose not to purchase from us? *

Please tell us where you made your eyewear purchase?

Did you purchase your contact lenses at Cranston Market Optometry? *

Yes No I do not require contact lenses

Knowledge of product *

Helpfulness of staff *

How would you rate the value of services and products you received? *

How well did we follow up with you? *

If you purchased contact lenses somewhere other than Cranston Market Optometry, what was the reason why you chose not to purchase from us? *

Please tell us where you made your contact lenses purchase?

Are there any individuals you would like to recognize for their service? *

Yes No

Who?

Identification (Optional)

Would you recommend our practice to your family and friends?

Yes No

If no, why not?

Would you like us to contact you in regards to a certain issue?

Yes No

If yes, please explain.

Do you have any recommendations that could improve the performance of our office?

Additional comments...

May we post your comments on our testimonial page?

Yes No

Name First Last

Wufoo

Service Rating

Scheduling

Eye Examination

Products

Identification (Optional)