1063 S. State Rd, Ste. #3, Davison, MI 48423
Phone: 810-658-2456 or Toll Free: 800-203-3937


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Patient Name: Date:
1. Convenience of our office hours:
2. Ease of making your appointment:
3. Promptness with which you were seen by the doctor:
4. Thoroughness of care you received:
5. Clarity of Doctor's explanations:
6. Doctor's friendliness and courtesy:
7. Staff's friendliness and courtesy:
8. Help with understanding your insurance coverage (If Applicable):
9. Selection of eyeglass frames:
10. Knowledge/assistance of optical staff:
11. Comfort and cleanliness of office:
12. Overall satisfaction with your visit:
13. Will you be returning to see us?:    
14. Would you recommend us to others?:    
15. Additional Comments/Remarks:
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