SUNY College of Optometry University Eye Center



Patient Satisfaction Survey

Thank you for choosing the University Eye Center (UEC) for your eye and vision care needs. As part of our continuous effort to improve the quality of our services, we survey our patients to learn about their experiences at our Center. Please take a few moments to complete our survey.

Your comments and suggestions will be confidentially reviewed and shared with our staff to help us improve upon our services. We strive to provide you with the highest quality of care.

Sincerely,

The Faculty and Staff of the University Eye Center

Survey Completed:


Date of Visit:  
 
 
First Visit?



Gender:


Age

Scheduling your appointment...
    Yes No N/A
1. Was the person who scheduled your appointment friendly and courteous?  
2. Were you able to get a convenient appointment?  
3. Was the person who scheduled your appointment helpful?  


Checking-in...
    Yes No N/A
1. Was the receptionist who checked you in friendly and courteous?  
2. Were you asked to verify your address, telephone and insurance information?  
3. Were you checked-in in a prompt manner?  
Once you checked-in, was your wait to see the doctor in excess of 15 minutes?  


Your examination...
    Yes No N/A
1. Was your doctor courteous and professional to you?  
2. Did the doctor answer your questions regarding today's visit?  
3. Explanations about your eye health and vision were satisfactory?  
4. Did you feel that the examination time was longer than you expected?  


Checking-out:
    Yes No N/A
1. Was the receptionist who checked you out at the end of your visit helpful and courteous?  
2. Did you leave our Center with a scheduled follow-up appointment?  
3. Was the cashier at the patient accounts window helpful and courteous?  
4. Did you feel that you had to wait long to see the cashier in order to pay?  


Overall Satisfaction...
    Yes No N/A
1. Would you return to this Center for your future eye care needs?  
2. Would you refer your friends or family members to this Center?  
3. Were you satisfied with your overall experience at this Center?  
 
 
 
Survey submission
(optional)
 


SUNY College of Optometry | University Eye Center | 33 West 42nd Street New York, NY 10036 | 212 938 4001