About Us

Friday,December 05,2008

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Patient Satisfaction Survey
It is our desire to offer the best of service to our patients. Please rate our performance by completing the following brief survey. Your input is very important in our effort to improve the quality of our service and your responses will be kept strictly confidential. The information you enter on this website is secured and will be kept completely confidential.
Please be sure to wait for the confirmation message before moving to another page or closing your browser.
Required fields are marked with an asterisk (*).

Top of Form

About You

Patient name (optional):

Email address:

Are you a new patient?

Yes No

Your age:

Sex:

Male Female

How did you schedule your appointment?
Telephone
In clinic
Website

Why did you choose OMNI Eye Specialists?
Current patient
Physician referral
Location of clinic
Family/friend recommended
Reputation of physician
Insurance required/in network
Advertisements
Internet
Newspaper
Radio
Television
Trade show

Your OMNI Eye Specialists Location and Doctor

OMNI Eye Specialists location: *

Please rate the following

Scheduling Your Appointment	Excellent	Very Good	Good	Fair	Poor
Ease of getting through to the scheduling office
Courtesy of the staff who answered your call
Convenience of the date and time of your appointment
Promptness in returning your call or online request
Check-in and Waiting	Excellent	Very Good	Good	Fair	Poor
Courtesy and helpfulness of the check-in staff
Comfort of the waiting area
Were you seen within a reasonable time for your appointment?
If not, how long was your wait?	15 minutes 30 minutes 45 minutes over 45 minutes
Communication about the reasons for any delay
During Your Exam	Excellent	Very Good	Good	Fair	Poor
Appearance of the exam room
Courtesy and ability of the exam staff
Courtesy of the doctor treating you
Willingness of doctor to listen and answer your questions
How clearly did the doctor explain your exam results and treatment process?
Our Billing Process	Excellent	Very Good	Good	Fair	Poor
Was the billing for your services accurate and understood?
If you contacted our billing office, please rate the following:
Ease of contacting one of our patient account representatives
Courtesy and helpfulness of our patient account representative
How well were your questions answered to your satisfaction?
In Your Words...	Excellent	Very Good	Good	Fair	Poor
How would you rate our overall service?
Would you recommend us?	Yes No
If not, why?
Where do you feel we need the most improvement?