Focal Point Survey

1. What were your primary reasons for choosing our practice for your eye health care?

Doctor
Location
Staff
High Tech Instrumentation
Service
Quality
Price
Selection

2. How was your overall experience at our office?

1
2
3
4
5

3. Did you feel you were listened to?

1
2
3
4
5

4. How well were your questions answered?

1
2
3
4
5

5. Were you presented with various product options?

1
2
3
4
5

6. Did you fill your prescription at our office? If no, please go to Question 10

Yes
No

7. How satisfied are you with your eyewear purchased at FP?

1
2
3
4
5
N/A

9. What was the primary reason you purchased your eyewear at FP?

Price
Service
Selection
Quality
Location
Other:

10. Are you satisfied with your eyewear purchased outside our office?

1
2
3
4
5
N/A

11. What was the primary reason you purchased your eyewear elsewhere?

Price
Service
Selection
Quality
Location
Other:
12. Comments:

13. Would you like us to respond to you regarding your comments?

Yes
No

14. Contact Information (Optional):