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Patient Satisfaction Survey


At Florida Eye Associates we strive for 100% Patient Satisfaction in all that we do. Please help us recognize our doctors and staff for meeting your expectations, or identify areas where we can improve by filling out this survey.

(Note: Submitting your name and your email address, while helpful to us, is not required. However, if a response is desired, please include your name.)

Thank you for sharing your experience with us.

    1a. Which of our doctors did you see today?
    Dr. BrownDr. ConsbruckDr. LalondeDr. FreemanDr. HershbergerDr. HaftDr. PaylorDr. PariharDr. RavinDr. RossDr. WeiserDr. Wang

    1b. Date of Visit?

    2. How were you made aware of Florida Eye Associates?
    T.V.RadioYellow PagesEstablished PatientMagazineWeb SearchPhysicianOther*

    For Other, how did you hear about us:

    Please rate the following experiences:

    3. Scheduling an appointment:

    4. Explanation of what to expect:

    5. Wait time-Our Front Desk Staff:

    6. Wait time-Our Nurse/Clinical Staff:

    7. Helpfulness of staff:

    8. Doctor's interest in condition:

    9. Doctor's explanation of your condition:

    10. Experience at our surgery center (if applicable):

    11. How was your insurance handled:

    12. Would you refer your family and friends to Florida Eye Associates?

    13. Please use the space below for additional comments:

    14. Would like a personal response? If yes, please provide us with your name and email address:



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