PATIENT SURVEY

We want to give you the best possible medical care! To do that we need your feedback. Please let us know what you think, and how we can improve, by answering this patient survey. All of your responses will be kept confidential, and your signature is not required. So please use this opportunity to speak freely. Thank you, Friedberg Eye Associates.
 
1. Which doctor did you see at your last visit? *
  Howard Friedberg, MD
  Andrea Friedberg, MD
  Debra Prieto, MD
  Louise Colletti, OD

2. How did you hear about our office? *
  Insurance
  Family and/or friends
  Physician
  Web
  Phone Book
  Magazine/Newspaper
  Other

3. How would you rate your overall satisfaction with us? *
  Very satisfied
  Somewhat satisfied
  Neutral
  Somewhat dissatisfied
  Very dissatisfied

If you are somewhat dissatisfied or very dissatisfied please describe.
 

4. What can we do to make your next visit with us more pleasant? *
 

5. How satisfied are you overall with the quality service of our staff? *
  Very satisfied
  Somewhat satisfied
  Neutral
  Somewhat dissatisfied
  Very dissatisfied

Additional Comments:
 

6. How likely is it that you would recommend us to a friend/colleague? *
  Very likely
  Somewhat likely
  Neutral
  Somewhat unlikely
  Very unlikely