Customer Satisfaction Survey

Please let us know how your last visit went.

On a scale from 1-10, would you recommend our practice to friends and family?*

Comments

Want to share more feedback?

Yes

Service Ratings

Communication prior to appointment

Appointment availability

Waiting room time

Fees

Quality of care from staff

Quality of care from doctor

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

Would you schedule appointments online?

Yes
No

Please tell us why not

Products

Satisfaction with eyeglasses

Satisfaction with contact lenses

Range of eyeglasses selection

Identification - This section is optional.

Why did you choose us for your eye health care?

Your Name (Optional)

First Last

Comments

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Customer Satisfaction Survey

Service Ratings

Scheduling

Products

Identification - This section is optional.

Office Hours

Lockhart Vision Source

We are a Proud Member of the Lockhart Chamber of Commerce

Service Ratings

Scheduling

Products

Identification - This section is optional.

Office Hours

Lockhart Vision Source

We are a Proud Member of the Lockhart Chamber of Commerce

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