Patient Review Form

We are extremely grateful that you are contributing your valuable time, your honest information, and your thoughtful suggestions.

Date of appointment *

Facility/Site *

Physician *

How would you rate the ease of calling our office and scheduling an appointment?

How would you rate the registration process? (signing in/completing registration forms)

How would you rate the courtesy, respect, and privacy shown to you by our staff and physician?

How would you rate the courtesy, friendliness and time spent with the physician to explain your condition?

How would you rate the time spent at our clinic?

How would you rate the wait time spent at our clinic?

During your appointment, was there anything you feel was outstanding?

During your appointment, was there any areas where we did not meet your expectations?

Would you recommend this provider's office to your family and friends?

Name (Optional)

May we contact you?

Phone or Email

Message

OUR MISSION

• To act as an advocate for our patients as we build successful health partnerships that nurture close personal rapport with both patients and their families, honoring the trust they have placed in us.
• To recognize that emotional and spiritual circumstances play a vital role in each patient’s sense of physical well-being.
• To provide high quality patient and parent education in a safe environment that supports our patients in their choices and their differences, remaining sensitive to the multiple needs of those we serve.

Patient Review Form

Excited to have our Round Rock, Georgetown, and Leander locations open to serve you better!

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Copyright © Clarity Eye Center | Notice of Privacy Practices (English) | Notificación de prácticas de privacidad (Español)

Patient Review Form

Excited to have our Round Rock, Georgetown, and Leander locations open to serve you better!

Archives

Categories

FOLLOW US

OUR MISSION

RECENT POSTS

OUR SERVICES

OUR LOCATIONS

Copyright © document.write(new Date().getFullYear()); Clarity Eye Center | Notice of Privacy Practices (English) | Notificación de prácticas de privacidad (Español)

Copyright © Clarity Eye Center | Notice of Privacy Practices (English) | Notificación de prácticas de privacidad (Español)