The Eye Center of Central PA strives to provide excellent patient care. In order to better our services, we rely on the feedback from our patients. Please take a moment to complete the survey, and thank you for your candid response

Doctor:
Location:

1.  Was this your first visit to this office
Yes No
2.  What is your age? years
 
3.  How did you hear about our practice?
Referred by another physician/optometrist
Friend or family member
Phone directory
Advertisement
Other 
4.   Were there any staff members, including our front office and technicians, who were especially helpful that you would like to mention?
   
5.   What suggestions do you have for how we can improve our services?
   
6. Please rank your satisfaction with our services in the following areas: A rating of “1” means you were extremely dissatisfied. A rating of “5” means you were extremely satisfied.
   Politeness of phone conversation with staff member12345
   Length of time it took to get an appointment12345
   Length of time spent in office waiting to be seen12345
   Physical environment of office12345
   Friendliness and helpfulness of staff upon arrival and throughout visit12345
   Friendliness and helpfullness of technicians during exam12345
   Friendliness and helpfullness of doctor/practitioner12345
   Medical/Ophthalmological knowledge of doctor12345
   Explanation of diagnosis and prescribed medications12345
   Assistance with billing procedures and completion of insurance forms12345
   Overall satisfaction with our practice12345
7. Would you recommend this practice to family or friends?
Yes No
8. If you would like someone to contact you, please complete the following (optional):
Name:
Phone:
Enter Authentication Code   v g p t k s 1    Below