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Thank you for allowing us to serve your eyecare needs.

 We want to know how you feel about our service.  Was your recent visit satisfactory? Did we measure up to your expectations? Is there some way in which our service could be improved? 

Your evaluation is important to us in our effort to improve our performance.  Please give us your comments on this questionnaire. 

We value your opinion about us as highly as we value your business. Thank you again for choosing us for your eyecare needs....and for the time to give us your comments. 

Thank you for your time.

Filling out the form below
will send a confidential e-mail directly to Dr. Endo!

How do we rate?
Excellent.
Above Average.
Average.
Below Average.

How was the speed of service?
Excellent.
Above Average.
Average.
Below Average.

How was the quality of patient care & service performed?
Excellent.
Above Average.
Average.
Below Average.

How does our pricing compare with what you expected?
Excellent.
Above Average.
Average.
Below Average.

How was the courtesy & friendliness of our personnel?
Excellent.
Above Average.
Average.
Below Average.

Were you greeted in a friendly manner & felt comfortable with our personnel?
Excellent.
Above Average.
Average.
Below Average.

How would you rate our office appearance?
Excellent.
Above Average.
Average.
Below Average.

How would you rate the competence of our personnel?
Excellent.
Above Average.
Average.
Below Average.

How would you rate your overall satisfaction?
Excellent.
Above Average.
Average.
Below Average.


Please list your phone or cel number, pager, email address or best way to reach you (optional).

Optionally, please indicate if the following will enable us to serve your better.
Earlier morning appointments starting at 7am
Earlier morning appointments starting at 8am
Later appointments after 6pm
Later appointments after 7pm
Drive thru pickups
Other

Are your interested in the following:

Your Additional Comments Please?