THE EYE INSTITUTE – PATIENT SURVEY

Welcome to your THE EYE INSTITUTE - PATIENT SURVEY

Name
1. How likely is it that you would recommend our services?
2. Office environment, cleanliness, comfort, etc.
3. Staff friendliness and courteousness
4. Total Wait time (waiting and exam rooms)
5. Level of trust in provider’s decisions
6. How well provider explains medical condition(s)
7. How well provider listens and answers questions
8. Spends appropriate amount of time with patients
9. Ease of scheduling urgent appointments
10. Number of office visits you’ve had in the last 2 years
11. Your gender
12. Your age group