Madelia Optometric Patient Satisfaction Survey
Thank you for selecting our office for your yearly comprehensive eye health care. We hope you were completely satisfied with your experience in our office. It is only through your openness that we can improve. Therefore, may we ask that you evaluate your most recent yearly comprehensive eye examination. We will share your comments with each staff member at our next office meeting. Please tell us your experiences in our office, good or bad.

We can assure you we will give your feedback our undivided attention, for we genuinely want to provide you the quality eye health care you deserve and have come to expect from our office.


Dr. Viktoria Davis & staff

Customer Care and Your Expectations
Please leave blank if you had no experience or no expectations.
Much better than expected
Better than expected
As expected
Worse than expected
Much worse than expected
1. How were your phone calls handled?
2. How easy was it to get an appointment when you wanted?
3. How was the length of time between entering our office and starting your examination?
4. How was the care you received from our technical staff?
5. How was the care you received from Dr. Davis?
6. How did Dr. Davis answer any concerns or questions you had?
7. How would you rate our fees?
What are the best days of the week for you to come to our office?
What are the best times of day for you to come to our office?
How likely are you to recommend our office to your family and friends?
Not at all likely
Definitely would recommend
Optional:
Your Name:
Your answer
Name of assistant(s) who helped you:
Your answer
Additional Comments:
Your answer
May we call you or email you to further discuss your comments?
Thank You Again for your help!!!!
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