To help us continually improve our service to patients, please take a few minutes to complete the following survey. Your time and input are greatly appreciated.

Please rate your experience in these areas of service:
* indicates required fields

1	2	3	4	5
Dissatisfied	Somewhat Dissatisfied	Somewhat Dissatisfied	Satisfied	Very Satisfied

The courtesy and knowledge of staff booking your consultation.	1	2	3	4	5
Availability of appointment times and ease to book initial consultation.	1	2	3	4	5
Information provided during consultation regarding surgery options available.	1	2	3	4	5
Professionalism and knowledge of person(s) performing eye testing.	1	2	3	4	5
Confidence in surgeons' experience and staff.	1	2	3	4	5
The level of technology provided by YELC.	1	2	3	4	5

Would you recommend YELC for a consultation or surgery to others? *	Yes No Why?
What was your initial impression of our practice?*
What can we do to improve the level of service to our patients?*
How important is pricing when making your decision about proceeding with refractive surgery?*
What is the “main” reason preventing you from scheduling surgery at YELC at this time?*
Do you think you will schedule surgery in the future?*
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