Feedback Form
We would love to hear your thoughts, suggestions, concerns or problems with anything so we can improve!
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
Date of visit
-
Day
-
Month
Year
Date
LOCATION VISITED ?
Please Select
The Eye Shop Ikeja
The Eye Shop Lekki (providence street)
The Eye Shop (Lekki Admiralty way)
The Eye Shop (Mega Plaza)
The Eye Shop (APO legislative quarters
The Eye Shop (Gwarinpa)
How would you rate our optical services?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate our waiting time ?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate our office environment, its cleanliness, comfort, lighting, temperature, etc. ?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate the availability of educational and informational materials regarding your vision were ?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate our staff's knowledge of your insurance coverage was ?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate our selection of frame, lens and accessories options ?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate the promptness of receiving your glasses or contact lens ?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate your overall experience at The Eyeshop ?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Was our clinical team courteous?
YES
NO
Would you recommend us to others?
YES
NO
If no, why not?
Please provide additional comments/suggestions on how to serve you better.
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