Patient Satisfaction Survey

The staff of Kung Eye continually strive to improve the service our patients experience. Please complete the form below and let us know your thoughts on the service you received, and anything we can do to improve, with a 10 being the highest. Thank you!

Patient Satisfaction Survey

Receptionists
How would you rate the phone manner of the receptionist who answered your call:
How easy was it for you to obtain an appointment?
How friendly & helpful was the receptionist to inform you regarding your referral?
How friendly & helpful was the receptionist at check-in & check-out?
How was your wait time?
Doctors & Technicians
Did our doctor answer your questions to your satisfaction?
How would you rank the bedside manner of the doctor?
How friendly & helpful was the technician?
Did the technician explain what test you were having and what the test was for?
Billing
How friendly & helpful was the billing staff when you called for a billing question?
Did the billing staff answer your billing question in detail?
How knowledgeable was the billing staff you spoke to?
Surgical Coordinator
How friendly & helpful was the surgical coordinator?
Did the surgical coordinator explain all the details related to your surgery to your satisfaction?
Was the surgical coordinator able to answer your questions?
When you called our office regarding your surgery, did our surgical coordinator return your call promptly?
How clean was the surgery center?
How friendly & helpful were the surgery center staff & nurses?
How would you rate your overall surgery experiences?
Other
Which doctor did you see?
How would you rate your overall experience at our office?
Would you recommend us to your family & friends?
Which Office did you go to?
What else can we do to improve your future experience at our office?
Other Comments
Name (optional)
First Last
Should there be any negative experience, is it ok for management to contact you?
If yes, please provide your Contact Telephone #:
Phone

Patient Satisfaction Survey

Patient Satisfaction Survey

Receptionists

Doctors & Technicians

Billing

Surgical Coordinator

Other

Have a question? Send us a message.