Patient Survey

We want to thank you for giving us the opportunity to serve you. Please help us enhance the experience of your next visit by taking a couple of minutes to tell us about the service you received at your most recent appointment. We appreciate your business and want to make sure your experience at our facilities is always positive.

Sincerely,
Steven Elliott, Elliott Eyecare
Phone: (865) 457-2020

Appointment Date:
Office Location:	Select One Elliott Eyecare Fountain City Eyecare Volunteer Vision Center
Optician:
Doctor:
1.]	Are you completely satisfied with our Eyecare Centers?
	Yes No
2.]	Would you refer a friend or family member to our Eyecare Centers?
	Yes No
3.]	Was your initial call to make an appointment completely satisfactory?
	Yes No
4.]	Were you greeted promptly and with enthusiasm when you arrived at the office?
	Yes No
5.]	Did the doctor exceed your expectations during your visit?
	Yes No
6.]	Were you completely satisfied with the frame selection?
	Yes No
7.]	Were you completely satisfied with the explanation of lenses and lens options?
	Yes No
8.]	Were you completely satisfied with the contact lens options?
	Yes No
9.]	If you answered NO to any of the above questions, please let us know what we can do to improve your experience:
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