How did we do (survey) ? Our aim is to offer you the highest quality service and care and to be your optometry clinic of choice for all your future eyecare needs. We thank you for taking the time to fill out the following questionnaire. Your answers will give us a good indicator of what you think about our standard of care, services, products and our relationship with you. All the fields with an (*) are mandatory. Step 1 of 3 33% Referred byTitleMrsMissMrDrFirst Name*Name*Phone ((###)###-####)*Email* Date of appointment Name of your optometristMake a selectionDr Edward M. TakahashiDr Edward T. TakahashiDr Donald SanfordOur CareHow would you rate your eye exam?Make a selectionExcellentVery goodGoodNot so goodPoorYour optometrist took the time to explain all the stages of your eye exam...Make a selectionExcellentVery goodGoodNot so goodPoorIn your opinion, would you say that the eye exam you received was thorough and complete?Make a selectionExcellentVery goodGoodNot so goodPoorOur ServicesThe communications with our office to arrange your appointment were:Make a selectionExcellentVery goodGoodNot so goodPoorWould you say that our clinic is easily accessible?Make a selectionExcellentVery goodGoodNot so goodPoorHow was your greetings at the reception?Make a selectionExcellentVery goodGoodNot so goodPoorDuring your visit, did we meet all your needs?Make a selectionExcellentVery goodGoodNot so goodPoorDo you have any suggestions on how we could improve? Our ProductsWould you say that our selection of sunglasses is:Make a selectionExcellentVery goodGoodNot so goodPoorWould you say that our selection of eye glass frames is:Make a selectionExcellentVery goodGoodNot so goodPoorDid our clinic staff answer all of your questions and offer appropriate solutions regarding our products offered (frames, sunglasses, contact lenses, sports and leisure glasses) ?Make a selectionExcellentVery goodGoodNot so goodPoorAre there any brands of frames or sunglasses that we didn’t have in stock that you would recommend we carry?If you did not purchase frames during your visit, please specify the main reason:Make a selectionI don't need frames at the momentNot enough selectionFrames were too expensiveI was not offered to purchase framesOther Relationship with youHow did you hear about our clinic?Make a selectionFront / outside signageClinic's websiteSearch engine (Google, Yahoo..)Newspaper adI have been a long-time patientReferal (please specify below)Specify your referralWould you recommend our clinic to your family and/or friend?YesNoIf you answered “no”, what would be your main reason(s) for hesitating to refer us?Other commentsPhoneThis field is for validation purposes and should be left unchanged.