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Patient Survey
Based on your most recent experience, how likely are you to recommend us to a friend or colleague?
*
1 - Not at all likely
2
3
4
5 - Extremely likely
How do you rate your experience with our staff in the office during your visit?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
How was your wait time to see the doctor?
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1 - Poor
2
3
4
5 - Excellent
How well did your doctor explain your exam findings?
*
1 - Poor
2
3
4
5 - Excellent
How satisfied are you with your doctor?
*
1 - Unsatisfied
2
3
4
5 - Very satisfied
How would you rate the staff on assisting you in your frame and/or contact selection?
*
1 - Poor
2
3
4
5 - Excellent
Does not apply
Overall, how satisfied are you with the selection of eyeglass frames?
*
1 - Unsatisfied
2
3
4
5 - Very satisfied
Does not apply
Overall, how satisfied are you are with The EyeDoctors Optometrists?
*
1 - Unsatisfied
2
3
4
5 - Very satisfied
Any other comments? Please let us know what you liked or would improve upon:
Office
*
- Please select -
Burlington
Council Grove
Emporia
Herington
Hiawatha
Junction City
Lawrence
Leavenworth
Manhattan
Marysville
North Topeka
Olathe
Olathe Mur-Len
Ottawa
Paola
Salina
Topeka
Doctor Name
*
- Please select -
I don't know
Kyle Bechtold, O.D.
Matthew Boswell, O.D.
Jayme Brown, O.D.
Jody Buller, O.D.
Brian Carpenter, O.D.
Andrea Chancey, O.D.
Lance Eisenbarth, O.D.
Ryan Emrick, O.D.
Kristine Fletcher, O.D.
Ashley Francis, O.D.
Erin Hamilton, O.D.
John Harvat, O.D.
Brian Horsch, O.D.
Brett Keller, O.D.
Sally Irwin, O.D.
Nathan Kluttz, O.D.
Anthony Luongo, O.D.
Amy Lower, O.D.
Scott McClain, O.D.
Angela MacDonald, O.D.
Sam Odle, O.D.
Bridgette Ostmeyer, O.D.
Jessica Putnam, O.D.
Edwin Rodriguez, O.D.
Richard Schroeder, O.D.
Angela Truelove, O.D.
Kimberly Walker, O.D.
Brent Wichert, O.D.
Christie Windhorst, O.D.
Doctor wasn't listed
How many years since your previous exam?
*
- Please select -
1 year
2-3 years
4-5 years
5+ years
First eye exam
How did you hear about us? (Select all that apply.)
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Other
First Name
Last Name
Email
TFT Dependency
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