Black Hills Regional Eye Institute Survey
1.

Was our staff friendly on the phone when you called to make your initial screeing appointment?

Yes
No
2.

During your screening appointment, was our staff friendly and helpful and did we answer all of your questions?

Yes
No
3.

Did you feel confident in the doctor's explanations and knowledge during your screening appointment?

Yes
No
4.

During your screening appointment, did you feel undue pressure to book your surgery?

Yes - Please comment below
No
  • Comment:

  • 500 characters left.
5.

How was your experience on your surgery day?

Fair Average Good Satisfactory Excellent       
      
6.

Who was your doctor on your surgery day?

Dr. Steve Khachikian
Dr. Terry Spencer
7.

During your entire experience, were you treated with care and respect?

Yes
No
8.

Was our facility clean, welcoming, and comfortable?

Yes
No
9.

What influenced your decision most to have Refractive Surgery? (Please check only one)

Hassle of Contact Lenses and/or Glasses
Advanced Technology
Experience of the Surgeons
My Occupation or Job
Sports
Social Interest
10.

Rate the importance of the following for selecting the Eye Institute Laser Vision Center.


(1 = Most Important)
 
Surgeons
Financing Options
Staff
Convenience and Location
Advanced Technology
Reputation
11.

How satisfied are you with your vision after surgery?

Very Satisfied
Satisfied
Other  
12.

Where did you hear about the Eye Institute Laser Vision Center? (Please check all that apply)

Eye Institute Website
Facebook
Internet Search with Google, Bing, Yahoo, etc.
Family or Friend
Radio
TV
Yellow Pages
Rapid City Civic Center
Rush Hockey
Optometrist
Billboard
13.

Have you referred family or friends to the Eye Institute for eye care?

Yes
No
14.

What did you like best about your experience at the Eye Institute?

 

350 characters left.
15.

Do you have any other comments?

 

350 characters left.
16.

Name (Optional)

We will have a quarterly drawing for one $50 gift certificate to a local Rapid City restaurant for those patients that fill out our survey and provide their name. 


First Name:
Last Name: