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Patient Survey
Based on your most recent experience, how likely are you to recommend us to a friend or colleague?
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1 - Not at all likely
2
3
4
5 - Extremely likely
How do you rate your experience with our staff in the office during your visit?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
How was your wait time to see the doctor?
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1 - Poor
2
3
4
5 - Excellent
How well did your doctor explain your exam findings?
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1 - Poor
2
3
4
5 - Excellent
How satisfied are you with your doctor?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
How would you rate the staff on assisting you in your frame and/or contact selection?
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1 - Poor
2
3
4
5 - Excellent
Does not apply
Overall, how satisfied are you with the selection of eyeglass frames?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
Does not apply
Overall, how satisfied are you are with Quantum Vision Centers?
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1 - Unsatisfied
2
3
4
5 - Very satisfied
Any other comments? Please let us know what you liked or would improve upon:
Office
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- Please select -
Belleville/Downtown
Belleville/West
Breese
Chester
Highland
Highland North
Maryville
Mattoon
Mount Vernon
Pinckneyville
Sparta
Staunton
Swansea
Waterloo
Doctor Name
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- Please select -
I don't know
Levant Akduman, M.D.
John F. Bush, O.D.
Sean L. Edelstein, M.D.
Homer A. Ferguson, M.D.
Julie Hendricks, O.D.
Andrew Ibisch, O.D.
Troy Johnson, O.D.
Bart A. Jones, M.D.
Michael P. Jones, M.D.
Enrique Peralta, M.D.
Melissa Schleeper Kiel, M.D.
Kristen Klauss-Reynolds, O.D.
Jeffrey M. Maher, M.D.
Mark Nekola, M.D.
Enrique Peralta, O.D.
Sabrina Schultz, O.D.
Brett Sobieralski, O.D.
Donald R. Unwin, M.D.
Daniel Walsh, O.D.
Eric Wigton, M.D.
Whitney Marlow, M.D.
Doctor wasn't listed
How many years since your previous exam?
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- Please select -
1 year
2-3 years
4-5 years
5+ years
First eye exam
How did you hear about us? (Select all that apply.)
TV
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First Name
Last Name
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TFT Dependency
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