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Dear Patient,

We want to thank you for giving us the opportunity to serve you. Please help us enhance the experience of your next visit by taking a couple of minutes to tell us about the service you received at your most recent appointment. We appreciate your business and want to make sure your experience at Clarkson Eyecare is always positive.

Sincerely,

Bill Jehling, President - Clarkson Eyecare
phone: 636.227.2600 ext. 2001

[ Appointment Date ]
[ Office ]
[ Optician ]
[ Doctor ]

 

1.] Are you completely satisfied with Clarkson Eyecare?

Yes No

2.] Would you refer a friend or family member to Clarkson Eyecare?

Yes No

3.] Was your initial call to make an appointment completely satisfactory?

Yes No

4.] Were you greeted promptly and with enthusiasm when you arrived at the office?

Yes No

5.] Did the doctor exceed your expectations during your visit?

Yes No

6.] Were you completely satisfied with the frame selection?

Yes No

7.] Were you completely satisfied with the explanation of lenses and lens options?

Yes No

8.] Were you completely satisfied with the contact lens options?

Yes No

9.] Please provide us with any feedback regarding your visit. Please enter comments in the box below.

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I consent to the use of my name and this text for advertising and promotional purposes in connection to my experience with Clarkson Eyecare without additional compensation.

 

 

   

Greater Metro Area - Saint Louis, MO