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Patient Experience Survey
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Would you prefer to view this survey in Spanish or English? / ¿Prefiere ver esta encuesta en español o en inglés?
English
Español
How did you hear about our services?
Community event
School
Friend or Family
Clinic Staff Referral
Online or Social Media
Other
Other:
¿Cómo se enteró de nuestros servicios?
Evento comunitario
Escuela
Amigo o familiar
Referido por el personal de la clínica
En linea o redes sociales
Otro
Otro:
How easy was it to schedule your appointment?
Very Easy
Easy
Neutral
Difficult
Very Difficult
¿Qué tan fácil fue programar su cita?
Muy Fácil
Fácil
Neutral
Difícil
Mut Difícil
Were you able to get an appointment in a reasonable amount of time?
Yes, very quickly
Yes, within a reasonable time
It took longer than expected
No, it was difficult to get an appointment
¿Pudo obtener una cita en un tiempo razonable?
Si, muy rapido
Si, en un tiempo razonable
Tome mas tiempo de lo esperado
No, fue difícil obtener una cita
How would you rate your experience with our staff?
Good
Fair
Poor
¿Cómo calificaría su experiencia con nuestro personal?
Buena
Regular
Mala
Did the doctor explain your eye health and exam results in a way you could understand?
Yes, very clearly
Somewhat clearly
Not clearly
¿El doctor explicó la salud de sus ojos y los resultados del examen de una manera que usted pudo entender?
Si, muy claramente
Mas o menos claro
No fue claro
Did you receive the services you needed during your visit?
Yes
No
Not Sure
¿Recibió los servicios que necesitaba durante su visita?
Si
No
No estoy seguro/a
If glasses were recommended, did our team explain the next steps clearly?
Yes
Somewhat
No
Not applicable
Si se recomendaron lentes, ¿nuestro equipo explicó claramente los próximos pasos?
Si
No
Mas o menos
No aplica
Overall, how satisfied were you with your visit?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
En general, ¿qué tan satisfecho/a estuvo con su visita?
Muy satisfecho/a
Satisfecho/a
Neutral
Insatisfecho/a
Muy insatisfecho/a
Would you recommend our services to family or friends?
Yes
Maybe
No
¿Recomendaría nuestros servicios a su familia o amigos?
Si
Tal Vez
No
Please share any comments about your experience, including what went well or how we could improve.
Por favor comparta sus comentarios sobre su visita. ¿Qué le gustó de su experiencia y qué podríamos mejorar?
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