Satisfaction Survey

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Please take a few moments and let us know what you thought of your last visit...

Provider
Location
Doctor
Service Ratings
	Great	Good	Fair	Poor	N/A
Communication prior to appointment
Appointment availability
Waiting room time
Fees
Quality of care from staff
Quality of care from doctor
Concerns or questions answered
Overall quality of care
Scheduling
Preferred day for appointments
Preferred time for appointments
Do you plan on returning for your next comprehensive examination?	Yes No
For no, please tell us why not
Would you schedule appointments online?	Yes No
Products
	Great	Good	Fair	Poor	N/A
Satisfaction with eyeglasses
Satisfaction with contact lenses
Range of eyeglasses selection
Identification (Optional)
Why did you choose us for your eye health care?
Your name (optional)
Additional comments

Hours & Directions

6805 Route 9, Suite 27 Astor Square
Rhinebeck NY 12572
Phone: 845-876-2222
Fax: 845-876-2045
Emergency Contact:

Emergencies call Dr Michael Madigan at 845-594-6809 or 845-594-6803

454 Warren Street, Hudson NY 12534
Phone: 518-828-0215
Fax: 518-828-0859
Emergency Contact:

845-594-6809