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Patient Satisfaction Survey

Please help us improve by rating your experiences at Eye Institute in the form below.

(or you can download and fill in a pdf version if you prefer).

* Denotes compulsory field


Excellent - 4, Good - 3, Fair - 2, Poor - 1
1. Appearance / cleanliness of facility
2a. Quality of services provided by Telephonist
2b. Quality of services provided by Receptionist
2c. Quality of services provided by Technician / Optometrist
2d. Quality of services provided by Theatre staff
2e. Quality of services provided by Doctor
3. Information provided on website?
4. Info provided in brochures?
5. Convenience of clinic hours?
6. Have your cultural, individual or other needs been met?
* 7. Overall satisfaction with your outcome?
* 8. Which Dr did you see?
9. Would you refer a friend or relative to us?
10. May we contact you with additional questions or clarify your comments?
(If yes to contacting you, please make sure you provide contact details down below)
We genuinely appreciate your feedback! Thank you.