We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Skip survey header

Perspective Eyecare Patient Survey

Thank you for agreeing to participate in this quick survey. Please answer the following questions honestly; everything you say will be kept in the strictest confidence. This survey will be used to better our office, our services and our staff, thereby giving you the service that you expect and deserve.

2. When was your most recent visit to our office? (If unsure, please estimate) Please click on the calendar to the right or use MM/DD/YYYY format. Thanks!

calendar

3. How did you choose us as your eyecare provider? (Please check all that apply)

5. Please rate us in the following areas

Business Hours
Doctor Availability
Office Cleanliness
Staff Friendliness

6. Thinking of your time spent with Dr. Kennedy, please mark whether you agree or disagree with each statement:

My examination was thorough and complete *This question is required
Dr. Kennedy explained my visual/medical conditions completely *This question is required
Additional test were fully explained *This question is required

8. If you did NOT purchase eyeglasses during your most recent visit to our office, please select the option(s) that most represent the reason(s) why not

No need for glasses
My prescription did not change
I was not eligible under my insurance plan
I couldn't find anything I liked
The cost was prohibitive
I'm coming back another day
Other Please enter an 'other' value for this selection.

9. Would you recommend us to your friends and/or family members?

10. What is something we could do to say THANK YOU for referring others to our office?

No need to do anything - it's MY pleasure!
Discount off future purchases
Credits for future purchases (Perspective Dollars - can save & add up)
Free Cleaning supplies or Contact Lens Solutions
Gift Certificate to local restaurant
Other

11. If you have any suggestions or comments, please leave them in the box below.

12. Thank you for taking our survey! If you would like to be entered to win a $50 Gift Card to our office, please fill in your information below! Your response is very important to us.

Name
Email Address

Survey Software powered by SurveyGizmo