Patient Survey

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How satisfied were you with your wait time?

How satisfied were you with our office's appearance?

How was your experience with our front office staff?

What was the name of your front office personnel?

How was your experience with Dr. Katie Bluhm?

How was your experience with our Contact Lens Technician?

What was the name of your Contact Lens Technician?

How satisfied were you with our eyewear selection?

How was your experience with our Optician?

What was the name of your Optician?

We appreciate any comments or testimonials, please leave them below.

Do we have permission to use your feedback as a testimonial for marketing purposes?*

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Would you mind leaving us your contact information?*

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Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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