We appreciate any feedback you have on the services our clinic provides. Please fill out the survey below.

Was our staff courteous and helpful?   Yes  No
Were you seen in a timely manner?   Yes  No
Was your examination thorough?   Yes  No
Were you able to understand your eye condition and treatment options?   Yes  No
Will you refer other patients to our office?   Yes  No
How would you rate your overall satisfaction with our office?   1  2  3  4  5
(1=very dissatisfied, 5=exceeding expectations)
Please let us know how we may improve your experience in our office:
    

If you would like to give us additional feedback, please contact Cheri at 763-428-3757.