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Piedmont Eye Center Patient Survey
Thank you for choosing Piedmont Eye Center for your eye care.
We want to hear your feedback so we can continue improving our care and share with staff when they have done an exceptional job. Please fill out this quick survey and let us know your thoughts.
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Patient Date of Birth
MM
/
DD
/
YYYY
Name (optional)
Your answer
Contact Number (optional)
Your answer
Which physician did you see?
*
Robert Vogel MD
Darin Bowers, MD
Gail Ganser, MD
Elizenda Ceballos, MD
Saxton Moss, MD
Gene Moss, Jr., MD
Golnaz Javey, MD
James Paauw, MD
How did you select Piedmont Eye Center?
*
Friend referred
Physician referred
Optometrist referred
Phone Book
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YOUR APPOINTMENT:
Ease of making appointment by phone.
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Appointment available within a reasonable amount of time.
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Excellent
Clear selection
The efficiency of the check-in process.
Poor
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Excellent
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Waiting time in the reception area.
Poor
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Waiting time in the exam room.
Poor
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Keeping you informed if your appointment time was delayed.
Poor
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Excellent
Clear selection
OUR STAFF:
The courtesy of the person who took your call.
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Excellent
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The friendliness and courtesy of the receptionist.
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The caring concern of the technician
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Excellent
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The helpfulness of the staff who assisted you with billing and insurance.
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Excellent
Clear selection
The professionalism and courteous manner of the doctor seeing you.
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Excellent
Clear selection
OUR COMMUNICATION WITH YOU:
Your phone calls answered promptly.
Poor
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Excellent
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Getting advice or help when needed during office hours.
Poor
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Excellent
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Explanation of procedure (if applicable)
Poor
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Excellent
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Effectiveness of our health information materials.
Poor
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5
Excellent
Clear selection
Thank you for participating in our survey. Please tell us where we did well and/or where we can improve.
Your answer
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