Patient Satisfaction Survey

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Thank you for visiting Suburban Associates in Ophthalmology. We hope you enjoyed your healthcare experience and received quality eye care. We want to receive your feedback so we can keep improving our practice. Please complete this 2-3 minute survey, and let us know your thoughts.

If you wish to discuss this survey, or your visit in more detail, please contact us at 847-253-4040 and ask our staff to speak to someone regarding the online patient satisfaction survey.

Please provide your full name (optional):

Which physician were you seen by? *

Naveed Ansari, MD

Janet Bresch, MD

Kimberlee Curnyn, MD

Cereesa Longest, MD

Gregory Nelson, MD

Mark Piotrowski, MD

Lena Shah, MD

Which office were you seen at? *

Arlington Heights, IL

Hoffman Estates, IL

Elk Grove Village, IL

What was the primary reason(s) you chose our practice for your eye care needs? *

Family or Friend Referral

Physician Referral

Website or Social Media

Reputation/Experience of Doctor

Available Technologies

Not Applicable - I am an Existing Patient

Other:

Required

How easy was it for you to schedule an appointment? *

Very Difficult

Very Easy

How long was your visit? *

less than 1 hour

1 hour

1.5 hours

2 hours

2.5 hours

3+ hours

Other:

How satisfied were you with the appearance and cleanliness of the office? *

Very Dissatisfied

Very Satisfied

How would you rate the professionalism of our staff? *

Very Poor

Very Good

Did you feel your questions were adequately answered by your physician and our staff?

Yes

Clear selection

How would you rate the quality of care you received? *

Very Poor

Very Good

How would you rate your overall experience? *

Very Poor

Very Good

How likely are you to recommend Suburban Associates in Ophthalmology to a friend or family member? *

Very Unlikely

Would Recommend

If unlikely, please tell us why:

Additional comments regarding your visit: *

Optional: Optical Department Questions

If part of your visit was with our optical shop, please take an extra minute to answer some questions regarding this portion of your visit before submitting the survey. If not, submit your survey now.

How long did you wait before seeing one of our optical staff members?

Under 15 minutes

15-30 minutes

30-60 minutess

Over an hour

Clear selection

How would you rate the quality of care you received?

Very Poor

Very Good

Clear selection

Did you purchase anything from our optical shop?

Yes

Clear selection

If no, what was the reason?

Additional comments regarding your visit with our optical department:

Submit

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