Customer Survey - Kilgore Vision Center


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Kilgore Vision Center - Patient Satisfaction Survey Questionnaire

Thank you for taking time to complete our Patient Satisfaction Survey. Your responses will help us serve you better.

Information provided through this survey is confidential and anonymous. If you have a specific question or concern, please contact our office toll-free at 800-844-4904, or locally 424-4900 in Mountain Home or 741-1910 in Harrison.

1) Which location did you visit?
    Mountain Home
    Harrison

2) Which department(s) of the clinic did you visit? Please select all that apply.
    Vision Center (Eye exams)
    Optical Shop (Eyewear/fittings)
    Surgery Center (Outpatient procedures)

3) Which Doctor did you visit?

   Ophthalmologists
        Kenneth Kilgore, MD
        Ethan Wright, MD
        Alice Laule, MD

   Optometrists
        Abe Akel Jr., OD
        Charles Crosslin, OD
        Steven Rae, OD

4) How would you rate the ease of reaching the clinic by phone?
    Excellent
    Good
    Fair
    Poor

5) Please rate the friendliness and courtesy shown to you by our staff:
    Excellent
    Good
    Fair
    Poor

6a) Were you called back from the front waiting room in a timely fashion?
    Excellent - seen at appointment time
    Good - seen within 10 minutes of appointment time
    Fair - seen within 20 minutes of appointment time
    Poor - waited over 20 minutes to be seen

6b) Please provide your evaluation of our optical shop service:
    Excellent
    Good
    Fair
    Poor

6c) Please provide your evaluation of our optical shop selection:
    Excellent
    Good
    Fair
    Poor

7) Did the staff treat you with courtesy and respect?
    Yes
    No

8) Was information explained to you in a way you could understand?
    Yes
    No

9) Did the staff listen carefully to your questions and concerns?
    Yes
    No - If not, please provide details:


           Please provide staff name if known:


10) Did your doctor address your questions and concerns?
    Yes
    No - If not, please provide details:


11) How did you hear about Kilgore Vision Center?
    Physician Referral
    Phone Directory
    Print Advertisement
    Friend/Family
    Website
    Event
    Billboard
    Medical or Vision Plan Provider

12) How would you rate the quality of care you received at Kilgore Vision Center?
    Excellent
    Good
    Fair
    Poor

13) How would you rate your overall experience at Kilgore Vision Center?
    Excellent
    Good
    Fair
    Poor

14) Would you recommend Kilgore Vision Center to others?
    Yes
    No

15) Is there someone you'd like to recognize for outstanding service or care?
    No
    Yes - If yes, please explain:


16) Please select the appropriate age group:
    19 years or younger
    20 - 44 years
    45 - 64 years
    Over 65 years

17) Please feel free to share with us any positive comments or areas of improvement:


18) If you would like us to contact you to discuss your satisfaction, please provide:
   Name:

   Phone Number:

   Best Day and Time to Call:

Providing quality eye care in a friendly, caring atmosphere is our goal at Kilgore Vision Center.

Your responses to the online survey will assist us in improving our patient care services to ensure that our patients have the best possible experience when visiting our facilities.

Completed online questionnaires submit to an independent marketing firm where the survey results are compiled and reports are provided to the physicians at Kilgore Vision Center. Your responses will remain confidential unless you specifically request to be contacted by the Kilgore staff.

Thank you for your participation.


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