Thank you for taking the time to complete this questionnaire. We would like to have your help in identifying the things we are doing right as well as identifying any problems. Our primary goal is to deliver excellent eye care and to deliver clear information about any eye problem that is present. Only with your comments can we measure our performance and be certain we are meeting the high standards we set for ourselves.

 

Which Physician did you see?
Alan B. Richards, M.D.
John D. Hinrichsen, M.D.
Amy E. Coburn, O.D.
What was the key reason(s) you chose our practice? (Select all that apply.)
Physician Referral  
Family/Friends Referral
Reputation/Experience of Doctor
Practice Website
Advertising/Billboards
Social Media (i.e., Facebook, YouTube, Twitter)
Online Doctor Reviews
Insurance Coverage
Other
Not Applicable-I am an Existing Patient
  When you called and/or visited our office, how would you rate our receptionists in the following areas: friendly, courteous, helpful, job know-how?
   
 
 
 
 
  When you visited our office, how would you rate our nurse/technician in the following areas: friendly, courteous, competent, professional?
   
 
 
 
 
  When you saw the doctor, how would you rate the amount of time he/she spent with you, answering your questions, and explaining medical procedures and treatments to your satisfaction?
   
 
 
 
 

When you visited our office, how would you rate our facility on cleanliness, comfort, parking, signs?

 

Would you recommend our practice to your family and friends?

 

Best email to contact you at: *required


 

Does Eye Docs for Kids have permission to use your comments in our marketing efforts?


 

   
 
   

 

 

 

 

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