Patient Satisfaction Survey

It is OCB's goal to provide our patients with the highest quality medical and surgical eye care. Ophthalmic Consultants of Boston (OCB) would greatly appreciate your assistance in providing your opinion on this survey.

Patient input has been valuable to OCB since the practice was formed in 1969. Your opinions and comments will assist us in making improvement to OCB's patient care services and to ensure that we are meeting your needs.

All answers and comments are confidential and intended to assist OCB in improving our services.

Thank you for taking the time to complete this survey.

Please note: the information sent through this form is not encrypted or sent through a secure server.

Your Name (Optional):
Date of Visit:	MM 123456789101112/ DD 12345678910111213141516171819202122232425262728293031/ YYYY 200720082009201020112012
Doctor:	== Select Doctor == Ann M. Bajart M.D.Husam Ansari M.D.Audrey S. Chan M.D.Tina Scheufele Cleary M.D.Michael E. Dalton O.D.Jay S. Duker M.D.Anne J. Farley O.D.Laura C. Fine M.D.Nicoletta Fynn-Thompson M.D.Mark P. Hatton M.D.Jeffrey S. Heier M.D.Bonnie An Henderson M.D.Michael W. Henderson O.D.Tom C. Hsu MDJames W. Hung M.D.Shannon D. Huntzberry O.D.B. Thomas Hutchinson M.D.Mami A. Iwamoto M.D.Jody K. Judge M.D.Claudine Y. Kawabata O.D.Mark D. Kirstein O.D.Michael G. Morley M.D.Michael F. Oats M.D.Will J. Price III, M.D.Michael B. Raizman M.D.Peter A. Rapoza M.D.Claudia U. Richter M.D.Stephen H. Rostler M.D.Jason S. Rothman M.D.Chirag P Shah M.D. , MPHBradford J. Shingleton M.D.Kenneth A. Stampfer MDMitchell B. Strominger M.D.Stephen M. Taylor O.D.Trexler M. Topping M.D.Maria F. Varela O.D.Torsten W. Wiegand M.D., Ph.D.Stephen A Youngwirth MD
Office:	== Select Location == OCB Beverly - Beverly HospitalOCB Beverly - Cummings CenterOCB BostonOCB CambridgeOCB MetrowestOCB Sandwich at Cape Cod EyeOCB WalthamOCB West Yarmouth
Was this your first visit to OCB?	yes   no

Courtesy and helpfulness of the telephone staff:	== Select == Excellent Very Good Good Fair Poor
Courtesy and responsiveness of the front desk staff:	== Select == Excellent Very Good Good Fair Poor
Courtesy and responsiveness of the clinical staff:	== Select == Excellent Very Good Good Fair Poor
Comfort and cleanliness of the exam room:	== Select == Excellent Very Good Good Fair Poor
Waiting time before being seen by the doctor:	== Select == Excellent Very Good Good Fair Poor
Doctor addressed your needs and/or concerns:	== Select == Excellent Very Good Good Fair Poor
Doctor's Efforts to include you in decisions about your treatment:	== Select == Excellent Very Good Good Fair Poor
Overall rating of the care received during your visit:	== Select == Excellent Very Good Good Fair Poor
Likelihood of you recommending this practice to others:	== Select == Excellent Very Good Good Fair Poor
What type of transportation did you take to get to the office? (If other, please explain in comments box below)	== Select == personal car wheel chair van family member's car taxi cab public transportation Other
How did you first learn of our office or who referred you to us? (If other, please explain in comments box below)	== Select == friend/relative another patient primary care physician ophthalmologist optometrist employer insurance company yellow pages website other
Do you have any suggestions or comments which might assist OCB to better serve you and others? Please check this box if you would like to be contacted by OCB regarding your comments. Enter email address or phone number to be contacted at: