SATISFACTION SURVEY

Location

Choose an Office

Communication prior to appointment

Availability of Appointments

Waiting room time

Fees

Quality of care from Staff

Quality of care from doctor

Concerns or Questions Answered

Overall quality of care

Preferred day for appointments

Preferred time for appointments

Do you plan on using Appleton Eye Care for you next comprehensive examination?

Yes

Would you schedule appointments online?

Yes

Satisfaction with eyeglasses

Satisfaction with contact lenses

Name (Optional)

First Name

Last Name

Why did you choose us for your eye health care?

Additional Comments