My Eye Doctor:       Dr. James Freund Dr. Heechung Ko Dr. Raymond Mint My Doctor Never Introduced Himself

Questions about my doctor:

Question #1
Do you usually wait more than 30 minutes to see your doctor?
Always Sometimes Never   
Comments:



Question #2
How well does your doctor listen to you and answer your questions?
Very Well Adequately Not Very Well I Am Usually Confused
Comments:

Question #3
How satisfied were you with the time the provider spent with you?
Very Satisfied Satisfied Somewhat Satisfied Dissatisfied Very Dissatisfied
Comments:

Question #4
How well does your provider explain your results and treatment in terms you can understand?
Very Well Adequately Not Very Well I Am Usually Confused
Comments:

Question #5
Does your doctor/practitioner answer your questions?
Always Sometimes Never
Comments:

Question #6
Are you treated courteously and respectfully by your doctor and his or her staff?
Always Sometimes Never
Comments:

Question #7
How likely would you recommend our practice to a friend or family member?
Definitely Recommend Possibly Recommend Never Recommend


Question #8
If you were referred to another doctor for treatment or surgery were you satisfied with the referred doctor?
Very Satisfied Satisfied Somewhat Satisfied Dissatisfied Very Dissatisfied Not Applicable
Comments:

Questions About Our Office Staff

Question #9
How were you treated by the person answering your call?
Very Well Adequately Not Very Well Poorly Not Applicable
Comments:

Question #10
How would you rate our front office personnel?
Very Satisfied Satisfied Somewhat Satisfied Dissatisfied Very Dissatisfied
Comments:

Questions About Our Office...

Question #11
Is the office clean, comfortable and professional in appearance?
Always Sometimes Never
Comments:

Question #12
Does the office provide convenient parking?
Always Sometimes Never
Comments:

Question #13
Do we answer our phones within 3 - 4 rings?
Always Sometimes Never Not Applicable
Comments:

Question #14
Have you ever been put on hold more than 3 minutes?
Always Sometimes Never Not Applicable
Comments:

Question #15
Are you able to get an appointment in what you consider to be a reasonable amount of time?
Always Sometimes Never
Comments:



Question #16
What are the most convenient office hours for you?
Early Morning (7 a.m. to 9 a.m.) Regular days (9 a.m. to 5 p.m.) Early evening (5 p.m. to 8 p.m.) Late evening (8 p.m. to midnight)


Question #17
Did our extended and weekend hours influence your decision to select our office as your health care provided?
Very Much Somewhat Not At All


Question #18
Does the office staff assist you with filling out insurance and other forms?
Always Sometimes Never Not Applicable
Comments:

Question #19
Does our office staff discuss financial arrangements and other personal matters with you in a private area?
Always Sometimes Never Not Applicable
Comments:



Question #20
How would you rate our office in assisting you with a problem with your insurance company?
Very helpful Somewhat helpful Helpful Somewhat unhelpful Not at all helpful Not Applicable

Question #21
Do you think fees for services provided by your doctor for your examination are reasonable?
Very Reasonable Reasonable Unreasonable Very Unreasonable
Comments:

Questions About Your Glasses 

Question #22
Did you purchase your eyeglass frames or lenses from the Vision Center?
Yes No (If "NO" please skip to Question #30)

Question #23
How did you find the selection of eyeglass frames?
Excellent Selection Very Good Selection Good Selection Fair Selection Poor Selection Not Applicable
Comments

Question #24
Did you find the optician to be helpful in selecting and fitting your eyeglass frames
Very Knowledgeable Somewhat Knowlegdgeable Poorly Knowledgeable Not Applicable
Comments:

Question #25
Do you think the price for your eyewear purchase was reasonable?
Very Reasonable Somewhat Reasonable Unreasonable Very Unreasonable Not Applicable
Comments:

Question #26
The optician did a good job educating me on lens and frame options such as antireflective coatings, transition lenses, and types of lens materials?
Did An Excellent Job Did A Adequate Job Did A Poor Job Not Applicable
Comments:

Question #27
Were your glasses ready in a reasonable amount of time?
Very Reasonable Reasonable Unreasonable Amount Of Time Not Applicable
Comments

Question #28
How likely would you recommend the Vision Center to a friend or family member?
Definitely Recommend Possibly Recommend Never Recommend Not Applicable
Comments:

Question #29
How satisfied were you with your optician?
Very Satisfied Satisfied Somewhat Satisfied Dissatisfied Very Dissatisfied
Comments:

Question #30
What influenced you in selecting our office for your eye care needs? 
Referral By Family Or Friend In Store Promotion Yellow Pages Newspaper Advertisement Television Advertisement Doctor Refrerral Price Other
 Other

Any additional comments you would like to add? 

Your Name:

Address:

City   State   Zip Code

Your e-mail address:


Your daytime phone number (if you would like to be contacted)


Would you like someone to contact you regarding this survey?
Yes, Please contact me No; there is no need to contact me

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