8381 Southpark Lane, Littleton, CO 80120 | 303.730.0404

Patient Education Videos

Phone: (303) 730-0404
Fax: (303) 730-6163

8381 Southpark Lane
Littleton, CO 80120
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Evergreen Office
Colorado Eye Consultants
30792 Southview Drive, Unit 201
Evergreen, CO 80439

(844) 9-EYECARE / (844) 939-3227
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Patient Survey

We value your opinion!!

Please complete the questionnaire regarding your care in our office. This information will serve as an ongoing evaluation of our services and help us improve where necessary. We welcome all comments.

Thank you for your time,
Dr. Damiano, Dr Forstot, Dr. Repine, Dr. Fish, Dr. Samples & Staff

Date of Service
Waiting Time
  Acceptable  Unacceptable
Doctor

Telephone Reception:

Very Satisfied = 5
Very Dissatisfied = 1
My call was answered in a timely fashion 5   4  3  2  1
I received courteous treatment by someone whom I felt wanted to help 5  4  3  2  1
The Telephone Receptionist was professional and knowledgeable 5  4  3  2  1

Reception:

 
Upon arrival, I was greeted in a friendly manner 5  4  3  2 1
I received courteous treatment during check-in and check-out 5  4  3  2  1
The Receptionists were professional and knowledgeable 5  4  3  2  1
Ease of check-in 5  4  3  2  1
Ease of check-out 5  4  3  2  1

Technical Staff:

 
When the Technician called you from the reception area, he/she introduced themselves, and identified you and the Physician you would be seeing 4  3  2  1
The Technician was professional and courteous 5  4  3  2  1
The Technician was knowledgeable and thoroughly answered my questions 5  4  3  2  1
I received explanation of procedures the Technician was performing 5  4  3  2  1
I was given ample opportunity to ask questions 5  4  3  2  1

Surgery Scheduling & Doctor Assistant Care:

 
The Doctors Assistant was professional and courteous 5  4  3  2  1
My call to a Doctors Assistant was returned in a timely manner 5  4  3  2  1
My questions related to my upcoming surgery were thoroughly answered 5  4  3  2  1

Physician:

 
I received prompt and courteous attention from my Physician 5  4  3  2  1
My physician was thorough and knowledgeable 5  4  3  2  1
My physician explained my condition and treatment options 5  4  3  2  1
My physician answered all of my questions 5  4  3  2  1

Optical:

 
I was cheerfully greeted by the Optician in the Optical store 5  4  3  2  1
The optician introduced/identified themselves 5  4  3  2  1
I was waited on by an optician in a timely fashion 5  4  3  2  1
The optician was professional and knowledgeable 5  4  3  2  1
I received my glasses within the time frame they gave me 5  4  3  2  1
I was satisfied with my purchase 5  4  3  2  1
Ordering contact lenses was any easy process 5  4  3  2  1
I received my contact lens order in a timely manner 5  4  3  2  1

Billing & Insurance:

 
I received a courteous and prompt response regarding my billing and insurance inquiry 5  4  3  2  1
The staff was professional and knowledgeable 5  4  3  2  1
I received a thorough explanation of my account and/or benefits 5  4  3  2  1

Quality of overall care:

 

Rate the appearance of our facility (neat, clean, welcoming, etc.) 5  4  3  2  1
Your experiences with our practice were such that you would see us again 5  4  3  2  1
You would recommend our practice to others 5  4  3  2  1
Comments
 

 

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