Patient Satisfaction Survey

In order to evaluate our service and better serve our patients, we are asking you to take a few minutes to evaluate your visit today. The survey can be dropped in the survey box in our waiting room or it may be mailed to Vantage Eye Center, Attention Practice Manager, 622 Abbott Street, Salinas, CA 93901.

1.	When telephoning our office, have you been placed on hold for long periods of time?	Yes No
	If yes, how long?	1-3 minutes 4 - 6 minutes Over 7 minutes
2.	When you telephoned our office, did the receptionist answer your call courteously?	Yes No
	Comments
3.	When you need an appointment, how many days do you usually have to wait before one is available?	Same day 1 - 3 Days 4 - 7 Days More than 1 week
4.	Did you receive a Reminder Card for your annual eye exam or 6 month follow up visit?	Yes No
	If so, what time period before the exam was the card received?	< 1 week 2 weeks prior > 3 weeks
5.	How long were you in the office from sign-in to discharge?	Less than 30 minutes 30 to 60 minutes 60 to 90 minutes Over 90 minutes
Please rate Vantage Eye Center on the following:
Scale Definition: (1 = Poor) (2 = Fair) (3 = Good) (4 = Excellent) (N/A = Not Applicable) 1 2 3 4 N/A
6.	How would you rate the receptionists on courtesy and promptness	1 2 3 4 N/A
7.	How would you rate the efficiency of check-in and check-out process	1 2 3 4N/A
8.	How would you rate the explanation of billing procedures by our receptionist ?	1 2 3 4N/A
9.	How would you rate our technicians on courtesy and efficiency in their work?	1 2 3 4N/A
10.	How would you rate the physician on patience, warmth, and interest in your problem?	1 2 3 4N/A
11.	How would you rate the physician on professional thoroughness in the examination?	1 2 3 4N/A
12.	How would you rate the optical department on courtesy and promptness?	1 2 3 4N/A
13.	How would you rate the billing department on courtesy, efficiency and promptness?	1 2 3 4N/A
14.	Rate the overall quality of care and service provided	1 2 3 4N/A
15.	Would you recommend our office to a friend or relative?	Yes No
16.	Which Physician did you see today? Please add any additional comments:	Blumenkranz Jack Jones Medcalf Paul Pruthi

Patient Satisfaction Survey

Please rate Vantage Eye Center on the following:

Scale Definition: (1 = Poor) (2 = Fair) (3 = Good) (4 = Excellent) (N/A = Not Applicable)

1 2 3 4 N/A