Survey

We want to know what you think and we want to reward you for telling us!

Please take a few minutes to answer questions about your experience with IEC. You will receive a $20 credit on your account for any future purchase at IEC. (One time credit of $20 per patient account; must be 18 years or older.)

We use survey information internally to improve our patient care. This information is never shared with parties outside of IEC; however, we may contact you if you have an issue you would like to be resolved. IEC doctors and staff are committed to patient satisfaction.

Please rate the following questions using scale of 1 to 5:

Quality Assurance Survey

1) Was our staff courteous and professional on the phone?
5 4 3 2 1 N/A
 
2) How courteous and professional was our staff during every aspect of your visit?
5 4 3 2 1 N/A
 
3) Were all your questions answered? Were we attentive to your needs?
5 4 3 2 1 N/A
 
4) How would you rate your overall experience in our facility?
5 4 3 2 1 N/A
 
5) Rate your satisfaction with IEC in regards the value of our services and products 
5 4 3 2 1 N/A
 
6) How well did we follow up with you if you ordered contacts or glasses?  
5 4 3 2 1 N/A
7) Would you like to be contacted in regards to a specific issue?
Yes No
 
8) Would you recommend IEC to your family and friends?
Yes No
9) What did you like best about your experience with IEC?
 
10) Do you have any recommendations that could improve the performance of our office?
11) Overall, do you believe the time you spent in our office was (check one):
  Comprehensive, just what I thought.
  Too long, could have taken less time.
  Too short, not enough time taken with my specific needs.
  
12) How have your heard about IEC? (Check all that apply)
  Television Promotional Flyer/Mailer
  Radio Internet Search / Website
  Yellow Pages Referral from Friend/Family
  Newspaper Referral from Employer
  Insurance Plan Book / Insurance Website   Location of Office
  Vision Screening
  
13) Is there a staff member you would like to recognize for their service?
 
16) Would you like for us to contact you in regards to a specific issue?  
Yes No
Date of Your Office Visit
 
 
Doctor Office Location
 
Purpose of Visit
 
Enter Comments Below:*
Patient Name: 
Relationship to Patient: 
Your First Name: 
Your Last Name:
Are you 18 or older? Yes  No
   
Address:

  
Home Phone: () -
Work Phone: () -  Ext:*
Best Time To Call:
E-Mail:
Confirm E-Mail:
Mobile/Other:*

 


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