Survey

American eye care center, aesthetics and skin rejuvenation
Patient Info

Patient Name*

Date

How was the wait time?

Did you get enough time with the doctor?

How easy was it to schedule an appointment?

How were your interactions with the doctor and office staff?

What else do you want us to know?

Dr. Peracha
Please rate the staff

COMPASSION ( 1-10)

KNOWLEDGE 1-10)

COMMUNICATION ( 1-10)

Dr. P (Potarazu)
Please rate the staff

COMPASSION (1-10)

KNOWLEDGE (1-10)

COMMUNICATION (1-10)

Dr. Kadijah
Please rate the staff

COMPASSION (1-10)

KNOWLEDGE (1-10)

COMMUNICATION (1-10)