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Patient Satisfaction Survey
How satisfied are you with how you were treated when you called to set up your consultation?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
How satisfied are you with the time between your consultation and your appointment?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
How was the quality of the explanation of your LASIK procedure?
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1 - Poor
2
3
4
5 - Excellent
How would you rate our office staff on greeting you on arrival?
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1 - Poor
2
3
4
5 - Excellent
How was the overall appearance of the LASIK center?
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1 - Poor
2
3
4
5 - Excellent
How was the quality of the explanation of your benefits and risks?
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1 - Poor
2
3
4
5 - Excellent
Does not apply
How satisfied are you with the fee charged for your procedure?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
Overall, how satisfied are you are with Clarkson LASIK?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
Any other comments? Please let us know what you liked or would improve upon:
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