Hawkesbury Optometric Clinic Feedback Form
Please help us with your thoughts at your recent visit. Thanks from all of us
Reason for coming to the office for an eye exam *
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How did you choose our clinic?
Scheduling
Preferred day of appointment
Preferred time of appointment *
Service Rating *
Great
Good
Fair
Poor
N/A
Communication prior to appointment
Appointment availability
Waiting time before pretesting
Fees and value of services
Quality of care from staff
Quality of care from doctor
Overall quality of care
What did you like most about the office?
Please elaborate...
Would you recommend our office to your friends?
Clear selection
How would you rate your overall experience at our office? *
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Best
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This form was created inside of Dr. Hazan, Professional Corp.