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Patient Feedback Form
How are we doing?
At Austin Ryan Optika we appreciate all kinds of comments, good and bad from our patients. Your feedback helps us decide what to keep doing, what to stop doing, and what to do better. You may also be letting us know about something we do not realize is happening. We welcome detailed feedback and if you choose to include your name and contact information, we are committed to responding to you within 30 days. Thank you for taking the time to write to us.
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Indicates required field
Check Which Applies:
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Compliment
Suggestion
Complaint
Which Office did you visit?
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New Paltz
Pleasant Valley
Your Name (Optional):
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Name Of Employee Who Worked With You (Optional)
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Date You Visited Us:
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Phone Number (Optional)
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How long was your wait time before speaking with a team member in our office?
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20 minutes or longer
15-19 minutes
10 minutes
Helped immediately
How well did you feel our Team Member understood what you were saying?
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Completely
Slight misunderstanding
Not well at all
How eager to help you was our Team Member?
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Extremely Eager
Moderately Eager
Not at all Eager
How quickly did our Team Member solve your problem or answered your questions?
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Very Quickly
Somewhat Quickly
Very Slowly
How knowledgeable did our Team Member seem to you?
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Extremely knowledgeable
Moderately knowledgeable
Not at all knowledgeable
Overall was your Experience with our office better then you expected, worse or about what you thought it would be?
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A great deal better
About what was expected
A great deal worse
Please describe your feedback and include any pertinent information:
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Submit
Home
Our Services
Comprehensive Eye Examinations
Spectacles
Contact Lenses
Lasik Surgery
About Us/Staff
Hours\\Locations\\Contact Us
Eyeglass Builder/Education
Care Credit Financing
On-Line Store
Patient Survey
Employment Opportunities