Patient Feedback Survey

Patient Feedback Survey
THANK YOU for selecting NaturalVue® (etafilcon A) Brand Contact Lenses. We hope that you are enjoying them.

We value your opinion so that we can assess the quality of our products and work to continuously improve them. To help us serve you better, please take 5-10 minutes to fill out this survey.

As a "Thank You" for completing the survey, your response is your chance to be enrolled in a drawing to win an annual supply of NaturalVue® product.

Click here for complete rules and privacy statements.
Data Analysis:

VTI hereby agrees not to publicly disclose your individual survey responses except in an aggregated format with other survey responses in which responses are not identifiable to an individual respondent. Neither will VTI sell nor share your personal information. Data will be pulled approximately within two (2) weeks of each quarter and annually as of December 1 to review and analyze. For more details regarding VTI’s privacy policy, click here:

US Privacy Policy

Global Privacy Policy

Drawing Rules:

All submissions must be received between January 1 and December 31 of the current calendar year. Any submissions received after such period will not be eligible for the prize drawing for the current calendar year but will be considered for the following calendar year.

Only patients, 18 years of age or older, who have been fit with a NaturalVue product prior and including this current calendar year are eligible to participate or win. First time patients who are filling an contact prescription and Medicaid recipients are not eligible to participate. No additional purchase necessary. Void where prohibited. Winning entry will be selected by random drawing from among all eligible submissions on or about two (2) weeks following each calendar quarter. Please allow 6-10 weeks for processing of winning entry. There will be exactly four (4) prizes awarded during the calendar year. The approximate retail value of each prize is $800. The odds of winning depend on the number of eligible submissions received.

You agree that Visioneering Technologies, Inc. (“VTI”) will own all right, title and interest to your responses to the survey, and that VTI may freely use your survey responses for any purpose, provided that VTI hereby agrees not to publicly disclose your individual survey responses except in an aggregated format with other survey responses in which responses are not identifiable to an individual respondent:*

I agreeI do not agree
Please select one:*

I acknowledge and represent that I am over the age of eighteen years and that I have read and understood this Release.I acknowledge and represent that the Subject is a minor and that I am the parent or Legal Guardian of the Subject and that I have the legal right and authority to execute this Release on behalf of the minor and that I have read and understood this Release.
MKT-GBL-NVU-VY2

Basic Information

Note: Your contact information is only necessary if you would like to be entered into the drawing to win NaturalVue® product. Otherwise, your initials would be acceptable.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age Range:*
Should be Empty:

	Extremely Poor (1)	Poor (2)	Satisfactory (3)	Good (4)	Excellent (5)	N/A
Overall Comfort
Overall Vision (Clarity)
Ease of Insertion

	Extremely Poor (1)	Poor (2)	Satisfactory (3)	Good (4)	Excellent (5)	N/A
Near (ex. Reading Your Phone)
Intermediate (ex. Computer Distance or Dashboard of Your Car)
Distance (ex. Street Signs, Trees)
Overall Handling
Overall Satisfaction

	Less Clear	The Same	Clearer
Near (ex. Reading Your Phone)
Intermediate (ex. Computer Distance or Dashboard of Your Car)
Distance (ex. Street Signs, Trees)

	Strongly Disagree (1)	Disagree (2)	Neither Agree nor Disagree (3)	Agree (4)	Strongly Agree (5)	N/A
NaturalVue® lenses provide me with excellent vision at all distances
I found handling my NaturalVue® lenses easy
If my practitioner agreed, I would like to continue with NaturalVue® contact lenses

Patient Feedback Survey

Your Satisfaction

Basic Information