How did we do?

Our aim is to offer you the highest quality service and care and to be your optometry clinic of choice for all your future eyecare needs.

We thank you for taking the time to fill out the following questionnaire. Your answers will give us a good indicator of what you think about our standard of care, services, products and our relationship with you.

All the fields followed by a * are mandatory.


Full name*
Daytime telephone*
(For confirmation only. We will not share your email address with third parties)
Date of your appointment*
Name of your optometrist:

Our Care

How would you rate your eye exam?

Your optometrist took the time to explain all the stages of your eye exam...
In your opinion, would you say that the eye exam you received was thorough and complete?

Our Services

The communications with our office to arrange your appointment were:
Would you say that our clinic is easily accessible?
Your greeting at reception was:
During your visit, did we meet all your needs?

Do you have any suggestions on how we could improve?
Yes    No

If you answered "yes", please explain:

Our Products

Would you say that our selection of eye glass frames is:
Would you say that our selection of sunglasses is:

Did we find the perfect frame for you?

Did our clinic staff answer all of your questions and offer appropriate solutions regarding our products offered (frames, sunglasses, contact lenses, sports and leisure glasses)

Are there any brands of frames or sunglasses that we didn’t have in stock that you would recommend we carry?
Yes    No

If "Yes", please specify:

If you did not purchase frames during your visit, please specify the main reason:

Other, please explain:

Relationship with you

How did you hear about our clinic?

Referral or other, please specify:

Would you recommend our clinic to your family and/or friend?
Yes    No

If you answered “no”, what would be your main reason(s) for hesitating to refer us?

Would you be interested in being kept informed of clinic promotions, offers or updates by email?
Yes    No

Other comments: