Oak Hill Eye Care - David W. Tybor, O.D. and Christi E. Payne, O.D.

We are continually reviewing our Optometry practice and welcome your honest views on the service we provide. Please read and complete the following questionnaire by choosing the response with which you most agree. All information you give will be treated as confidential and will not be used to identify you.

Section 1 - Booking of Your Appointment and Arrival
		Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
1.	When making your appointment, the appointment offered to you was suitable. ______________________________________________________________
2.	On arrival to the practice you were dealt with promptly and professionally. ______________________________________________________________
3.	The reception and waiting area was clean and organized. ______________________________________________________________
4.	The clinic was running on time and you were seen at your appointment time. ______________________________________________________________
5.	You were kept informed of any delay. ______________________________________________________________
Section 2 - Your Eye Examination
6.	The optometrist put you at ease by explaining what was going to happen before the tests. _____________________________________________________________
7.	You were given the opportunity to express concerns/feelings to the optometrist. _____________________________________________________________
8.	The optometrist explained the results of eye examination clearly. _____________________________________________________________
If you had spectacles dispensed as your last appointment please complete section 3. Contact lenses wearers please complete section 4
Section 3 - Dispensing of Your Spectacles
9.	You are happy with the help/advice you received while choosing your spectacles. _____________________________________________________________
10.	Your spectacles were ready in the time quoted. _____________________________________________________________
11.	Your spectacles were fit to your satisfaction. _____________________________________________________________
12.	A member of staff fully explained how to clean and maintain your spectacles. _____________________________________________________________
13.	Have you had any problems with your spectacles since receiving them?	Yes	No
	If yes, has the problem been resolved?	Yes	No
Section 5 - Contact Lens Consultations (Existing wearers please go to Question 16)
14.	The Optometrist fully explained the choice of contact lenses available. _____________________________________________________________
15.	You were taught how to insert, remove and clean your contact lenses as a first-time wearer. _____________________________________________________________
16.	You were given clear advice on what to do if you had a problem with your lenses. _____________________________________________________________
17.	Have you had any problems since the contacts were fit?	Yes	No
	If yes, has the problem been resolved?	Yes	No
18.	Based on the eye care you received you plan to return to this practice. _____________________________________________________________
19.	Would you recommend the practice to other friends and family? _____________________________________________________________	Yes	No
	Please feel free to make any further comments about the practice.

Thank you for taking the time to complete this questionnaire. Your comments are much appreciated and will be used to improve future services.

Oak Hill Eye Care
6000 W. William Cannon Dr., Bldg A, Ste. 100
Austin, TX 78749
512.288.0444

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