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Take a Survey
Take a Survey

* Indicates required information
* (date of service) * (city office is located in)

WE STRIVE FOR

Win a Free Pair of Glasses!

It is Henry Ford OptimEyes’ goal to provide quality service and personal attention that more than meets your expectations. Please take a few minutes to complete this short survey. The survey asks you to rate our office in a number of areas on a 1 - 5 scale, with 5 being the highest.

We strive for 5s! If for some reason you can’t give us all 5s, please write your comments as to why so that we can improve our service.

Upon receipt of your survey, we’ll enter your name to win a FREE* pair of glasses!

Please feel free to call me with your comments or suggestions at (248) 588-9300.


Nanette Michaels
Vice President of Operations

*up to $300 value

OUR STAFF
1 2 3 4 5 N/A
Very Poor Poor Fair Good Very Good  
How would you rate our staff’s responsiveness and accuracy with your requests for information?
How would you rate the way you were greeted?
How would you rate our staff’s attentiveness, thoroughness and concern?
How would you rate Dr. (enter doctor’s name)  thoroughness and attentiveness?
How would you rate the explanation of your insurance coverage?
IF YOU HAVE NOT GIVEN US ALL “5s”, PLEASE TELL US WHY SO WE CAN IMPROVE OUR SERVICE(S):

OUR SERVICES
1 2 3 4 5 N/A
Very Poor Poor Fair Good Very Good  
How would you rate our frame selection?
If you purchased glasses, how would you rate the explanation of the features and benefits of additional lens options?
If you purchased contacts, how would you rate the instruction on the care of your contact lenses?
How would you rate the length of time you waited for your scheduled appointment?
How would you rate the length of time it took to receive your new eyewear?
IF YOU HAVE NOT GIVEN US ALL “5s”, PLEASE TELL US WHY SO WE CAN IMPROVE OUR SERVICE(S):

OVERALL SATISFACTION
1 2 3 4 5 N/A
Very Poor Poor Fair Good Very Good  
How would you rate our office in appearance?
How would you rate the friendliness of our staff?
How would you rate the quality of your glasses/contacts?
Would you recommend Henry Ford OptimEyes to your family and friends?
Were you satisfied with your overall care/service?
IF YOU HAVE NOT GIVEN US ALL “5s”, PLEASE TELL US WHY SO WE CAN IMPROVE OUR SERVICE(S):

PLEASE TELL US MORE
Were there any additional services you needed that we were not able to provide?
Did any particular employee(s) make your office visit especially memorable?
Is there anything else you'd like to comment on?
First Name
Last Name
Street
City
State
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Phone
 


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