Skip survey header

Satisfaction Survey for Modern Eyes Optometry

1. Were you satisfied with our communication prior to your recent visit? *This question is required.
2. Were you acknowledged when you first entered our office? *This question is required.
3. Was our front office staff courteous and helpful? *This question is required.
4. Were you seen in a timely manner for the services provided during your recent visit? *This question is required.
5. Which optometrist did you see during your recent visit? *This question is required.
6. Were you satisfied with the explanation of your visual conditions and treatment options? *This question is required.
7. Was your optometrist caring and thorough? *This question is required.
8. Who assisted you with your eyewear selection? *This question is required.
9. Were you satisfied with the assistance our optical staff provided in selecting eyewear? *This question is required.
10. Was our optical staff caring and friendly? *This question is required.
11. Are you satisfied with the overall performance of your new eyewear from our office? *This question is required.
12. Would you refer family and friends to our office? *This question is required.
14. Where have you seen our information? Please check all that apply. *This question is required.
15. Were you aware we provide care for urgent eye issues like sudden vision changes, infections, inflammation and eye injuries, including removing foreign bodies from the eye, with no referral required? *This question is required.
16. Were you aware we provide comprehensive dry eye consultations and treatment plans? *This question is required.
17. Were you aware we offer prescription and non-prescription eyewear such as sunglasses, eyeglasses, safety glasses, sports goggles and contact lenses? *This question is required.
18. Were you aware comprehensive eye examinations are recommended every one to two years for adults and annually for infants, children and seniors? *This question is required.
22. Thank you for taking the time to complete our survey.
Please enter your contact information below.
If you have completed this survey on behalf of a dependant under 18 years of age, please enter their name below.
To submit your feedback, please click the teal 'arrow' button or teal 'submit' button at the end of this survey.