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CEI Quality Care Survey

Complete survey to be registered for monthly drawing to win a $25 gift card

Thank you for choosing Cincinnati Eye Institute. Our goal is to provide outstanding quality patient service. Your feedback is very important to us, as we will use your opinion to improve the quality of our care and services.


Patient Name
(Optional)
E-Mail Address *
(Required for drawing entry)
E-Mail Address 2 *
Date of Birth MM/DD/YYYY (Optional)
Date of Service (Optional)
Location *
Doctor *

 

Survey Questions
Poor
Fair
Good
Very Good
Excellent
 
1
2
3
4
5
1) The ease of making an appointment by phone:
2) The professionalism and courtesy of our staff:
3) The quality of medical care provided:
4) Medical concerns were explained in a way you could understand:
5) The amount of time you spent waiting was reasonable given your ophthalmic condition:
6) Your overall satisfaction with our practice:
Additional Comments:

Thank you... We greatly value your opinion.

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Cincinnati Eye Institute, serving Cincinnati, Blue Ash, Middletown OH, Edgewood ,
Lawrenceburg, Milford OH, Mason OH, West Chester , Covington KY, Dayton, Hillsboro OH, and the surrounding area.

Main Office | 1945 CEI Drive | Cincinnati, OH 45242 | 513-984-5133
www.cincinnatieye.com

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