Which Doctor did you see?*Choose OneDr. Arash MansouriDr. William ColemanDr. Adrian BiscombeDr. Angela SantigaDr. Christopher TestaDr. Joseph DzibelaDr. Tracy DzibelaDr. Stefani DeasDr. Derek EvansChris Adams, Hearing SpecialistNo Doctor SeenWould you like to provide additional info? Phone Number Email Address Which location did you visit? Would you like to be contacted by a staff member? When you called for an appointment, were you satisfied with the response from the person who answered the telephone? 1 2 3 4 5 When you arrived at the office, did you find the receptionist to be:Friendly and courteous? 1 2 3 4 5 Helpful?Helpful? 1 2 3 4 5 How acceptable was the amount of time spent in the reception area and examining room, before seeing the doctor? 1 2 3 4 5 When you were called to the examining room, did you find our Nurse/Technician to be:Friendly and courteous? 1 2 3 4 5 Competent and professional?Competent and professional? 1 2 3 4 5 Sympathetic and caring?Sympathetic and caring? 1 2 3 4 5 During your examination, did you find the doctor to be:Friendly and courteous? 1 2 3 4 5 Competent and professional?Competent and professional? 1 2 3 4 5 Sympathetic and caring?Sympathetic and caring? 1 2 3 4 5 Did the doctor spend an appropriate amount of time with you, answer your questions and explain medical procedures to your satisfaction? 1 2 3 4 5 How satisfied were you with the doctor's diagnosis and treatment recommendations? 1 2 3 4 5 If new glasses or contacts were recommended, did the doctor discuss your lens options with you in detail? 1 2 3 4 5 If you went to our optical shop, did you find the salesperson to be friendly and courteous? 1 2 3 4 5 When asking billing or insurance questions, did you find our billing and insurance staff:Friendly and courteous? 1 2 3 4 5 Helpful?Helpful? 1 2 3 4 5 Rate your overall experience with the practice: 1 2 3 4 5 Would you recommend our practice to your friends and family? 1 2 3 4 5 Do you have any additional comments? Δ
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