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Fraser Valley Cataract and Laser Patient Feedback

Please share your feedback on your recent appointment with us. Your input helps us improve. This completed questionnaire will be entered into a draw for a chance to win a gift basket. Stay tuned on Instagram for the winner announcement. Thank you for your time!

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Patients Name  *
Date of Birth *
Phone Number  *
Email *
Date and time of appointment *
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Location  *
Did you get a reminder call/text for your appointment? *
Required
Which Doctor's did you see? *
How was the wait time?
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What could we do to make the wait feel better?
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How would you rate your experience with our technicians during testing and pre-workup?
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How was your interaction with the doctor's you saw on that day?
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How was your check out experience?
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Do you feel all your questions/concerns were addressed?
*
Was there a specific staff member that stood out to you in our clinic today? Could you be specific with dates and staff names if possible.
If applicable, what did you think about your Lasik testing and counselling?
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If applicable, what did you think about your cataract testing and counselling?
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If applicable, did you find it easy to obtain written material from our office on your procedure? 
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What did you find the best part of your experience? (Select all that apply)
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In what ways do you think we can make your experience even better? (Select all that apply)
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Overall, how satisfied are you with your experience at FVCL? *
 How would you rate the cleanliness of the office?
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How did you like our website, easy to navigate? Any suggestions?
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If applicable, were you made aware of our other services such as cosmetic services, pain clinic, and Lasik?
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If applicable were you made aware and comfortable with any costs of products and services that are not MSP covered?
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Is there anything else you would like us to know about your appointment today?
Do we have your consent to use your comments for marketing purposes?  *
Would you like to be followed up regarding your feedback and any improvements we could make? *
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