Patient Satisfaction Survey
​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? *
Which office were you seen at? *
What was the primary reason(s) you chose our practice for your eye care needs? *
How easy was it for you to schedule an appointment? *
Very Difficult
Very Easy
How long was your visit? *
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?
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?
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?
Clear selection
If no, what was the reason?
Additional comments regarding your visit with our optical department:
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