info@wlei.com
Contact Us
Location
Windsor
Call Toll Free
800-663-4733
Book Your Consultation
Toggle navigation
Home
Home
About Us
Dr. Tayfour
Procedures
Technology
Am I a Candidate?
For Optometrists
Patient
Surgery Survey
Back to Contact Us
Name *
First & Last Name
Surgery Date
Date
How did you hear about us? Please specify media: i.e., television, radio, print, billboard or other?
What were your motivating factors for choosing us?
What was your main concern prior to surgery?
What was it that alleviated this concern for you?
What improvements should be made related to informing you of expectations, before, during and after surgery?
On a scale of 1-10 (10 being the highest) please rate our reception staff on your day of surgery.
On a scale of 1-10 (10 being the highest) please rate our clinical staff on your day of surgery.
On a scale of 1-10 (10 being the highest) please rate our doctors on your day of surgery.
On a scale of 1-10 (10 being the highest) please rate your overall experience on your day of surgery.
Please feel free to comment further.
In what way(s) could your overall surgical experience have been improved?
Would you recommend our facility to others?
If no, why?
Would you be willing to speak to prospective patients regarding your experience?
If yes, please inform us of the best time of day and number you could be reached at.
Any additional comments to better serve our patients are welcomed.
Joomla Forms
makes it right. Balbooa.com