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278 Benedict Ave. Ste 300. Norwalk, OH 44857 | 419-668-3295
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Patient Satisfaction Survey
Wait Time
*
5 - Extremely Satisfied
4 - Satisfied
3 - Neutral
2 - Dissatisfied
1 - Extremely Dissatisfied
0 - Not Applicable
Office Appearance
*
5 - Extremely Satisfied
4 - Satisfied
3 - Neutral
2 - Dissatisfied
1 - Extremely Dissatisfied
0 - Not Applicable
Front Office Staff
*
5 - Extremely Satisfied
4 - Satisfied
3 - Neutral
2 - Dissatisfied
1 - Extremely Dissatisfied
0 - Not Applicable
Name of Front Staff Personnel
Doctor
*
5 - Extremely Satisfied
4 - Satisfied
3 - Neutral
2 - Dissatisfied
1 - Extremely Dissatisfied
0 - Not Applicable
Name of Your Doctor
Contact Lens Technician
*
5 - Extremely Satisfied
4 - Satisfied
3 - Neutral
2 - Dissatisfied
1 - Extremely Dissatisfied
0 - Not Applicable
Name of Your Contact Lens Technician
Optician
*
5 - Extremely Satisfied
4 - Satisfied
3 - Neutral
2 - Dissatisfied
1 - Extremely Dissatisfied
0 - Not Applicable
Name of Your Optician
Eyewear Selection
*
5 - Extremely Satisfied
4 - Satisfied
3 - Neutral
2 - Dissatisfied
1 - Extremely Dissatisfied
0 - Not Applicable
Overall Experience
*
5 - Extremely Satisfied
4 - Satisfied
3 - Neutral
2 - Dissatisfied
1 - Extremely Dissatisfied
0 - Not Applicable
We appreciate any comments or testimonials
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Yes
No
Thank you for completing this survey
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Name
Address
Street Address
Address Line 2
City
ZIP Code
Email
Office Hours Norwalk
Mon
day
8:00am
4:30pm
Tues
day
8:00am
4:30pm
Wed
nesday
8:00am
4:30pm
Thurs
day
8:00am
4:30pm
Fri
day
8:00am
4:30pm
Sat
urday
Closed
Sun
day
Closed
Optical Shop
We have a fabulous selection of high-quality frames on display ranging from budget to the latest designer fashion.
Click Here to Access Our Optical Shop