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Exit Survey
 
 
It is Planchard Eye and Laser Center's goal to provide our patients with the highest quality medical and surgical eye care. Planchard Eye and Laser Center (PELC) would greatly appreciate your assistance by providing your opinion in the following survey. It will take approximately two minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no Patient input has been valuable to PELC since the practice was formed in 1989. Your opinions and comments will assist us in making improvement to PELC's patient care services and to ensure that we are meeting your needs.

All answers and comments are confidential and intended to assist PELC in improving the delivery of services to our patients.

Thank you for taking the time to complete this survey. Please begin the survey now by clicking on the Continue button below.

 
 
 
What was your Date of Service?
 
 
Your Name (Optional):
First Name : 
Last Name : 
 
 
 
Which Doctor did you see?
 
 
 
Was this your first visit to the Planchard Eye and Laser Center?
 
Yes
 
No
 
 
 
How would you rate the Courtesy and helpfulness of the telephone staff?
 
Excellent
 
Very Good
 
Good
 
Fair
 
Poor
 
 
 
How would you rate the Courtesy and helpfulness of the Front desk staff?
 
Excellent
 
Very Good
 
Good
 
Fair
 
Poor
 
 
 
How would you rate the Courtesy and responsiveness of the Clinical staff?
 
Excellent
 
Very Good
 
Good
 
Fair
 
Poor
 
 
 
How would you rate the comfort and cleanliness of your exam room?
 
Excellent
 
Very Good
 
Good
 
Fair
 
Poor
 
 
 
How would you rate your waiting time before being seen by the doctor?
 
Excellent
 
Very Good
 
Good
 
Fair
 
Poor