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Home » Patient Center » Patient Satisfaction Survey

Patient Satisfaction Survey

Please rate the following categories based on your experience in our office.
How would you rate your wait time?
- Extremely Satisfied
- Satisfied
- Neutral
- Dissatisfied
- Extremely Dissatisfied
- Not Applicable
How would you rate our office's appearance?
- Extremely Satisfied
- Satisfied
- Neutral
- Dissatisfied
- Extremely Dissatisfied
- Not Applicable
How would you rate our front office staff?
- Extremely Satisfied
- Satisfied
- Neutral
- Dissatisfied
- Extremely Dissatisfied
- Not Applicable
What was the name of your Front Staff Personnel?
How would you rate your Doctor?
- Extremely Satisfied
- Satisfied
- Neutral
- Dissatisfied
- Extremely Dissatisfied
- Not Applicable
What was the name of your Doctor?
How would you rate your Contact Lens Technician?
- Extremely Satisfied
- Satisfied
- Neutral
- Dissatisfied
- Extremely Dissatisfied
- Not Applicable
What was the name of your Contact Lens Technician?
How would you rate your Optician?
- Extremely Satisfied
- Satisfied
- Neutral
- Dissatisfied
- Extremely Dissatisfied
- Not Applicable
How would you rate our Eyewear Selection?
- Extremely Satisfied
- Satisfied
- Neutral
- Dissatisfied
- Extremely Dissatisfied
- Not Applicable
What was the name of your Optician?
We appreciate any comments or testimonials, please leave them below.
Do we have permission to use your feedback as a testimonial for marketing purposes?*
- Yes
- No
Would you mind leaving us your contact information?*
- I will leave my information
- No thanks, I would prefer to stay anonymous
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20/20 Visions

100 Carr Rd.
Plymouth, WI 53073

Phone: 920-893-3937
Fax: 920-892-6668

Monday: 8:30 AM - 5:00 PM
Tuesday: 9:30 AM - 6:00 PM
Wednesday: 8:30 AM - 5:00 PM
Thursday: 8:30 AM - 5:00 PM
Friday: 8:30 AM - 5:00 PM
Saturday: Closed
Sunday: Closed

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20/20 Visions - Located at 100 Carr Rd., Plymouth, WI 53073 Phone: 920-893-3937 https://www.20-20visions.com/

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