Patient Survey - Clarkson Eyecare LASIK

How satisfied are you with how you were treated when you called to set up your consultation?*
1 - Unsatisfied 2 3 4 5 - Very satisfied
How satisfied are you with the time between your consultation and your appointment?*
1 - Unsatisfied 2 3 4 5 - Very satisfied
How was the quality of the explanation of your LASIK procedure?*
1 - Poor 2 3 4 5 - Excellent
How would you rate our office staff on greeting you on arrival?*
1 - Poor 2 3 4 5 - Excellent
How was the overall appearance of the LASIK center?*
1 - Poor 2 3 4 5 - Excellent
How was the quality of the explanation of your benefits and risks?*
1 - Poor 2 3 4 5 - Excellent Does not apply
How satisfied are you with the fee charged for your procedure?*
1 - Unsatisfied 2 3 4 5 - Very satisfied
Overall, how satisfied are you are with Clarkson LASIK?*
1 - Unsatisfied 2 3 4 5 - Very satisfied
Any other comments? Please let us know what you liked or would improve upon:
First Name
Last Name
Email
Comments
This field is for validation purposes and should be left unchanged.