1. Full Name
2. Email
3. ignore this

Please rate the following aspects of our office:

• Understanding your ophthalmic needs Excellent Good Poor
• Communicating clearly and effectively Excellent Good Poor
• Keeping you informed of progress Excellent Good Poor
• Meeting timescales Excellent Good Poor
• Responding promptly to your needs Excellent Good Poor
• Was the office clean and inviting? Yes No

How long did you have to wait?

• To schedule an appointment 0 to 7 days 1 to 2 weeks 2 to 4 weeks
• To wait to be greeted by our registering staff 1 to 10 mins 10 to 20 mins 0 to 30 mins.
• To be seen by the doctor's assistant/ technician 1 to 10 mins 10 to 20 mins 0 to 30 mins.
• To be seen by your doctor less than 1 hr. 1 hr more than 1 hr.
• Physician's Name

Additional Information

• How would you rate the staff? Friendly & helpful Average Varies each visit Poor service
  
  
  
• Based on your experience, how likely are you to recommend VHSC to friends and family Very likely Somewhat Likely Unlikely
• 
  Would you like to be added to our contact / mailing list so we can inform you about VHSC events, health fairs and newsletter? Yes Sign Me Up No Thank You