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1. Please specify your gender.
Male
Female
2. Which age group do you fall into?
Below 20
21 to 30
31 to 40
41 to 50
51 to 60
61 to 70
70 to 80 and above
3. How much time do you usually wait before you see the Ophthalmologist/Optometrist?
4. Are you able to schedule your appointment in a reasonable amount of time?
Yes
No
5. What would you say about the person handling the phone queries?
Very prompt
Slow
Gave the advice needed
Well informed and knowledgeable
Courteous
Helpful
Rude
Not well informed
Other, please specify
6. How did you find our Ophthalmologist/Optometrist in the following areas?
Other, pease include any additional information you'd like us to be aware of
7. What do think regarding Southside Eyecare and Optical in the following areas?
Please include any additional information about our staff that you would like us to be aware of
8. How was your experience when visiting our contact lens department?
The contact lens staff was kind and courteous
The contact lens staff was well informed and knowledgeable
The contact lens staff took adequate time explaining things
The contact lens staff was rude
The contact lens staff explained costs reasonably
The contact lens staff was prompt
The contact lens staff was slow
The contact lens staff was helpful
Not applicable. Didn't visit the contact lens department.
Other, please specify
9. How was your experience when visiting our Optical department?
The Optical staff was professional and courteous
The Optical staff was well informed and knowledgeable
The Optical staff took adequate time explaining things
The Optical staff was rude
The Optical staff explained costs reasonably
The Optical staff was helpful
The Optical staff was prompt
The Optical staff was slow
Not applicable. Didn't visit the optical department
Other, please specify
10. What will be the reason for you to refer a friend or family members to our Practice?
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