Optical Customer Feedback Form
Thank you for visiting EyeCare Opticals. Your feedback is invaluable to us to enhance our services and patient care. We truly appreciate your time and input!
Patient Information
Name
Contact Number
Please rate your experience (Poor, Satisfactory, Good, Very Good, Excellent, Not Applicable)
1. Courtesy & Professionalism of Staff
Poor
Satisfactory
Good
Very Good
Excellent
2. Waiting Time & Service Efficiency
Poor
Satisfactory
Good
Very Good
Excellent
3. Explanation of Frame/Lens/Contact Lens/Sunglass Options
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
4. Product range Selection & Display Range
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
5. Cleanliness & Hygiene of the Optical Store
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
6. Billing Ease & Transparency
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
7. Delivery time experience
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
For Prescribed Glasses/Contact Lenses (Once Spectacle is Received)
8. Fit & Adjustment of Spectacles/Contact Lenses
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
9. Vision Clarity & Lens Quality
Poor
Satisfactory
Good
Very Good
Excellent
Not Applicable
For Prescribed Glasses/Contact Lenses (Once Spectacle is Received)
10. Comfort & Fit of Sunglasses
Poor
Satisfactory
Good
Very Good
Excellent
11. Lens Quality (Anti-glare, UV Protection, etc.)
Poor
Satisfactory
Good
Very Good
Excellent
Recommendation
15. Based on your experience, how likely are you to recommend EyeCare Hospital to others (Such as friends, family, or others)
0
1
2
3
4
5
6
7
8
9
10
Suggestions
16. Please share any comments, suggestions, or areas of improvement:
Submit Survey