Patient Feedback on Lasik, laser eye surgery at New Vision - LASIK India

Patient Feedback Form

Posted on August 30, 2010

by Samir Shah

First Name:

Last Name:

What were you treated for?

When was the procedure done? Day:

When was the procedure done? Month:

When was the procedure done? Year:

At which Center was the procedure done? Who was the doctor who treated you?

Please rate us on a scale of 1 -5 for the following parameters, where 1 is extremely satisfied and 5 is extremely dissatisfied. Pre-operative consultation

Thoroughness of Examination

Behavior of staff

Punctuality (of?)

Explanation of procedure

Queries explained satisfactorily

Procedure-day Experience

Behavior of staff

Behavior of Doctors

Punctuality

Fees taken as explained before

Post-operative Experience

Behavior of staff

Ease of getting appointments

Punctuality

Thoroughness of Examination

Explanation of queries

Do you still need to wear glasses?

Yes

Do you experience any vision problems?

Yes (please describe your problems)

please describe your problems

Overall, how satisfied are you with the treatment? Please rate us on a scale of 1-5 where 1 is extremely satisfied and 5 is extremely dissatisfied.

Would you recommend LASIK to a friend? Why?

Yes

Would you recommend LASIK to a friend? Why?

Patient Feedback Form

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