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Patient Satisfaction Survey
Our goal is to provide you with an exceptional experience when you visit Vision Care Associates. That mission is accomplished through a team effort of many individuals who are committed to your total satisfaction.
Get Your $10 Gift Certificate
Your input is very important to us. Participate in our Patient Satisfaction Survey and we will mail you a $10 gift certificate that can be used for any future visit to VCA. There is a limit of two (2) Survey $10 Gift Certificates per household per year. Please only complete one survey for each office visit and allow 4-6 weeks for receipt of your gift certificate.
We respect your privacy. Therefore, your personal information is never shared with parties outside of Vision Care Associates. However, we may contact you if you have an issue you would like resolved. We use survey information internally to improve our patient care and office practices. Please take a moment to let us know how we are doing.
InstructionsYou must be 18 years or older to complete our survey.Please use the following rating scale where applicable when responding5) One of the best experiences I've had in a Doctor's office4) Better than most experiences in other offices3) About the same as other offices I've visited2) Worse than in other offices1) I wouldn't return1) During the appointment scheduling process, how professional and courteous was our staff on the phone or in person?
2) Were you made aware that you can download patient forms at home from our Website in order to reduce your time spent with forms in the office?
3) Did you use the forms on our Website prior to your first exam with us?
4) During any telephone interactions you had before or after your exam, how would you rate our ability to address your questions, concerns, or needs?
5) Overall, how would you rate your experience with Vision Care Associates on the telephone?
6) During your office visit, how well did we listen to your specific needs?
7) How courteous and professional was our staff during every aspect of your visit?
8) How well did we follow up with you if you ordered trial contact lenses?
9) Would you recommend our practice to your family and friends?
10) What DOCTOR did you see on your recent visit to VCA? Please type the name below.
11) How would you rate the overall experience with your DOCTOR during your exam?
12) Do you have any recommendations that could improve the performance of our office?
13) Do you have any recommendations to help your DOCTOR improve the exam experience?
14) Are there any individuals that you would like to recognize for their service? Please list the names below.
15) Overall, do you believe the time you spent in our office was (check one):
The remaining questions pertain to your experience at the Arboretum Visionworks if you shopped for eyewear and/or contact lenses at this location after visiting our office.
If you did not shop at the Arboretum Visionworks after your visit to VCA, proceed to the bottom of the survey to input your Name and Address in order for us to send your $10 Gift Certificate.
1) How satisfied were you with the time it took to be greeted and acknowledged by the optical staff?
2) How satisfied were you that the sales associate was able to help you select the best product for your needs?
3) Rate your level of satisfaction with the look and fit of your eyewear?
4) How satisfied were you with Visionworks ability to make your eyewear to the proper prescription?
5) How satisfied were you that your eyewear was ready by the date it was promised?
6) Based on price and quality of your eyewear, how do you feel about the overall value of your purchase?
7) Based on your experience at the Arboretum Visionworks, would you return in the future?
8) Was there anything in particular that you would like to share about your experience at the Arboretum Visionworks?
PATIENT INFORMATION -- for security purposes, this survey is not linked to your patient records. Therefore, you must fill out your complete name and address information in order for us to send you your $10 Gift Certificate.
Patient Name:
Relationship to patient:
Your Name:
Address:
City, St. Zip:
Phone number:
PATIENT SURVEY
Date of your visit
