Chili Vision Group Survey

Chili Vision Group
Customer Satisfaction Survey

Please fill out the following questions based on the degree to which you agree or disagree with 5 being strongly agree, and 1 being strongly disagree. If the question does not apply to you, please feel free to leave it blank.

I was able to arrange an appointment easily.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

At my appointment, I was seen in a timely manner.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

Staff members were courteous, helpful, and friendly.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

Doctors were courteous, helpful, and friendly.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

The doctors thoroughly explained my visual conditions and my treatment.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

I was pleased with the selection of eyewear and/or contact lenses available at Chili Vision Group.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

My overall experience at Chili Vision Group was positive.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

The facilities are attractive and comfortable.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

I will continue to shop for eyewear and/or contact lenses at Chili Vision Group.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

I feel Chili Vision Group offers better customer service than competitors.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

My wait time was less at Chili Vision Group than at competitors.

	1	2	3	4	5

1 is Strongly Disagree, 5 is Strongly Agree

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Education:
Annual Household Income:
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