GlanvilleHussing.com

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Satisfaction Survey

I f you have visited us recently and would like to share your comments for the continued improvement of our practice please fill out and submit the survey form below. It is anonymous but an email address is appreciated. All information will be kept strictly confidential.

Which Office did you visit?:

Which Doctor did you see?:

What was the Nature of your visit?:

Were you greeted promptly and courteously?:
Yes
No

Did you have to wait long to see the Doctor?:
Yes
No

Did the Doctor spend an appropriate amount of time with you?:
Yes
No

Did the Doctor thoroughly explain the results of your exam?:
Yes
No

Was the Front Desk Staff polite and helpful?:
Yes
No

Was the Optician courteous and helpful?:
Yes
No

Did the Optician explain all the options available to you?:
Yes
No

Did the Optician answer your questions competently and completely?:
Yes
No

Was the variety of eyewear satisfactory?:
Yes
No

Did the staff thoroughly explain our fees and answer your insurance questions?:
Yes
No

Were your eyeglasses ready in a reasonable amount of time?:
Yes
No

Were your eyeglasses adjusted comfortably upon delivery?:
Yes
No

When purchasing Contacts from us do you:
Pick them up at the Office.
Have them direct shipped from the manufacturer.

Overall, How would you rate the Practice?:

Your Email Address Please:

Additional Comments:

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