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Patient Survey

Would you recommend Eye Surgical Associates to others?*

What did you see us for at your last appointment?*

Was this your first appointment?*

Which doctor did you see?*

Ease of scheduling an appointment* Excellent Good Fair Poor N/A

Returning your calls in a timely manner* Excellent Good Fair Poor N/A

Length of waiting time to see your doctor* Excellent Good Fair Poor N/A

How well your doctor answered your questions* Excellent Good Fair Poor N/A

How well your doctor explained things to you* Excellent Good Fair Poor N/A

How well you were treated by our staff* Excellent Good Fair Poor N/A

Knowledge and professionalism of your doctor* Excellent Good Fair Poor N/A

Knowledge and professionalism of our staff* Excellent Good Fair Poor N/A

Appearance and atmosphere of our facility* Excellent Good Fair Poor N/A

How may we contact you?* Phone Email Mail

May we add you to our email list for newsletters and appointment reminders?*

If yes, please enter your email address

What was the best thing about your visit?*

Other comments/suggestions

How did you hear about us?*

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Email Address*

Gregory E. Sutton, M.D.
Max W. Linder, M.D.
Vincent J. Sutton, M.D.
Thomas A. Graul, M.D.
Matthew H. Wood, M.D.
Donald P. Sauberan, M.D.
Daniel A. Chruscicki, M.D.
David S. Pan, M.D.
Kaylyn R. Jackman, M.D.

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