This free survey is powered by
  1. Surveys
  2. 2013
  3. January
  4. Q
  5. QuestionPro : Basic Customer Satisfaction
0%
Exit Survey
 
 
Hello:

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact our office at 413-528-3355 or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
* How would you rate your level of satisfaction with us?
Highly dissatisfied Somewhat dissatisfied Neutral Somewhat satisfied Highly satisfied
 
 
 
* How likely would you be to recommend us to a friend or colleague?
Very unlikely Somewhat unlikely Neutral Somewhat likely Very likely
 
 
 
What suggestions do you have or improvements would you like to see made?
   
 
 
 
* Who did you see when you came to the office? (Select all that apply)
 
Dr. Joseph B. Gold
 
Dr. Diane E. Singer
 
Not Applicable
 
Ophthalmic Technician
 

 
 
 
When were you last seen in our office?
   
 
 
 
If you would like to be contacted by our practice manager or by the physician please enter your name and phone number below as well as the most convenient time to contact you:
   
 
Thank you for completing our survey. Your response and comments will help us to better serve you in the future.