- Patient Survey -
I would like to personally thank you for choosing Eyedentity for your eye
care, and I sincerely hope your experience was the very best you have
ever had. 

In order to continually improve our services, Eyedentity would like for you to
evaluate our performance. Please call me personally on my cell at 337-5927 if
you have any unresolved problems or if there is any way that I might assist you.

Eyedentity has been in business for 14 years in Franklin under my ownership, and I will
work hard to be your eye care provider for the next 20 years. Your valuable answers are
integral for our quality management and improvement program, and thank you again for
your honest evaluation.

Best regards,

William Y. Cuthbertson OD FAAO
Eyedentity, PC
Short form
(complete this if you do not have time for the complete survey)
Scale  (5=Outstanding / 1=Poor)
1. Overall Customer Service Experience n/a
2. Overall Exam Experience n/a
3. Overall Contact Lenses Experience n/a
4. Overall Eyeglass Experience n/a
5. Overall Value Experience n/a
6. Would you recommend Eyedentity to friends and family. Yes    No
  WORKING WITH US Scale  (5=Outstanding / 1=Poor)
1. You were treated politely when you first contacted us. n/a
2. We are conveniently located. n/a
3. We offer convenient appointment times. n/a
4. We greeted you, were helpful, and you were seen promptly. n/a
5. The office is clean, tidy, and comfortable. n/a
6. We are easy to do business with. n/a
7. Our staff was professional, knowledgeable, and attentive to your needs. n/a
8. Your pretesting and eye exam was thorough, unhurried, with easy to understand explanations. n/a
9. Your doctor thoroughly explained your eye health exam results, and answered any questions. n/a
10. Your doctor was interested in you and your concerns. n/a
11. We had a good selection of eyewear in all price ranges. n/a
12. Our eyewear prices, your insurance coverages, and our billing process was easy to understand. n/a
13. Your fees were accurately billed. n/a
14. Your optician was friendly, attentive, and found you the perfect frame in the price range you wanted. n/a
15. Your eyeglasses fit and look perfect when delivered. n/a
16. Your eyewear order was ready when promised, in a period of time that was better than average. n/a
17. You are completely satisfied with your new eyewear. n/a
18. Your contact lens exam was thorough and accurate. n/a
19. Your contacts were ordered and delivered in better than average time. n/a
20. You feel that your new contacts provide excellent vision and comfort. n/a
21. You received good value in your contacts. n/a
22. You received good value in your glasses. n/a
23. You are likely to recommend a friend or family member to us for professional eye care, contacts, and eyewear. n/a
  Please share with us any problems you had, or compliments for extraordinary service:...  
  Can we contact you for more details in order to solve a problem?     Yes     No
  Best time to call -
  Name -           Phone -           Email Address -