Thank you for visiting Triangle Eye Institute. We value you as a patient and appreciate you choosing us as the provider for your vision needs. To help us continue to improve our high quality of service, we invite you to take a brief survey. In appreciation of your taking the time out of your busy schedule, we will email you a $10 gift certificate to be used towards any future purchases.
The feedback in the survey is sent directly to us and is not shared with anyone. We only use the information you provide to improve our services to our patients and create an environment in which you and your family receive the attention and care you expect and deserve.
Your Name: * First Last
Relationship to patient: * ---SelfSpouseParentGuardianOther
Email *
Doctor ---Dr. Osama SaidDr. Asma KhanDr. Sanjay PatelDr. Amjad Badwan
Date of your office visit ...
Which location did you visit ---RaleighMorrisville
How did you hear about us: *
How satisfied were you with our services? (5 = Highly Satisfied, 1 = Not Satisfied)
Was it easy to schedule an appointment?: * 5 4 3 2 1
Were you greeted in a prompt and friendly manner?: * 5 4 3 2 1
Did the doctor’s assistant educate you on the various pre-test exams that were preformed?: * 5 4 3 2 1
Did you doctor address all of your concerns?: * 5 4 3 2 1
Was your waiting time reasonable?: * 5 4 3 2 1
Was your treatment clearly explained?: * 5 4 3 2 1
How would you rate the cleanliness of the facility?: * 5 4 3 2 1
Were you satisfied with the eyewear lines available?: * 5 4 3 2 1
Were your charges and insurance coverage clearly explained?: * 5 4 3 2 1
How would you rate your overall experience?: * 5 4 3 2 1
Would you return to our practice in the future ? yes / no: * Yes No
Would you refer a friend to our practice? yes / no: * Yes No
If you decided to purchase your eyeglasses or contact lenses somewhere else, please tell us why: * Selection Price Service Other
Please feel free to add any comments or suggestions you have for us:
If there are any particular issues or concerns you would like us to contact you about, please let us know:
We appreciate your input. We will contact you to discuss the survey with you if you have requested for us to do so.
Morpheus would like to know if you are human? *
