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?
Yes No 

2. Have your calls to the office been handled courteously and efficiently?
Yes No 

3. When you called, were you able to make an appointment in a reasonable amount of time?
Yes No 

4. (NEW PATIENTS ONLY) Did our Welcome Brochure provide you with the information you needed? (directions, insurance information, office hours?)
Yes No 

5. Was our staff courteous, friendly and helpful during the time you spent in our office?
Yes No 

6. Did our staff communicate with you regarding your child’s progress during the visit?
Yes No 

7. Do you feel you had enough time with the doctor when you were here?
Yes No 

8. Do you feel your doctor interacted well with your child?
Yes No 

9. Do you think that the office staff made a good effort to try to make your child comfortable during his/her exam?
Yes No 

10. Do you feel the doctor explained your child’s condition and treatment in a clear and understandable manner?
Yes No 

11. Considering the services you received from our office, do you feel your waiting time was reasonable?
Yes No 

12. Would you recommend Pediatric Eye Care of Maryland to a friend?
Yes No 

13. Your overall satisfaction rating of your experience with our office was?
Excellent Good Fair poor 

Date Seen

Examining Doctor

Patient Name

Phone Number

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