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Online Survey - Share Your Opinions With Us!
Please take a few moments and let us know what you thought of your last visit...
Provider
Doctor
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Dr. Amy R. Gallegos O.D.
Dr. Suzanne M. Karlqvist O.D.
Service Ratings
Great
Good
Fair
Poor
N/A
Communication prior to appointment
Appointment availability
Waiting room time
Fees
Quality of care from staff
Quality of care from doctor
Concerns or questions answered
Overall quality of care
Scheduling
Preferred day for appointments
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
No Preference
Preferred time for appointments
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7am-9am
9am-5pm
5pm-8pm
8pm-10pm
No preference
Do you plan on returning for your next comprehensive examination?
Yes
No
For no, please tell us why not
Would you schedule appointments online?
Yes
No
Products
Great
Good
Fair
Poor
N/A
Satisfaction with eyeglasses
Satisfaction with contact lenses
Range of eyeglasses selection
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Good
Too few
Too many
Too many of the same type
Identification (Optional)
Why did you choose us for your eye health care?
Your name (optional)
Additional comments
