Patient Satisfaction Survey

Every staff member at Pediatric Eye Care of Maryland, formerly Dankner Fiergang Eye Associates is committed to your child’s eye care. We want you to have the very best service we can offer as dedicated professionals. In order to help us achieve this goal, we would appreciate your taking the time to complete this survey. This will help us to continually improve the quality of care that your family receives here. Your response will remain confidential.

1. Was this your first appointment as a new patient?
YesNo

2. Have your calls to the office been handled courteously and efficiently?
YesNo

3. When you called, were you able to make an appointment in a reasonable amount of time?
YesNo

4. (NEW PATIENTS ONLY) Did our Welcome Brochure provide you with the information you needed? (directions, insurance information, office hours?)
YesNo

5. Was our staff courteous, friendly and helpful during the time you spent in our office?
YesNo

6. Did our staff communicate with you regarding your child’s progress during the visit?
YesNo

7. Do you feel you had enough time with the doctor when you were here?
YesNo

8. Do you feel your doctor interacted well with your child?
YesNo

9. Do you think that the office staff made a good effort to try to make your child comfortable during his/her exam?
YesNo

10. Do you feel the doctor explained your child’s condition and treatment in a clear and understandable manner?
YesNo

11. Considering the services you received from our office, do you feel your waiting time was reasonable?
YesNo

12. Would you recommend Pediatric Eye Care of Maryland to a friend?
YesNo

13. Your overall satisfaction rating of your experience with our office was?
ExcellentGoodFairpoor

Date Seen

Examining Doctor

Patient Name

Phone Number

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