Online Survey

Patient Survey

We appreciate you taking the time to fill out this short survey so we at Eye Associates of Colorado Springs can better serve our patients.

1. Which Doctor at Eye Associates of Colorado Springs examined you? --Choose your Physician-- Dr. Barad Dr. Carlson Dr. Gardner Dr. Marshall Dr. Pikkula Dr. Schunk Office

2. Which Location of Eye Associates of Colorado Springs did you visit? --Choose the Office Location-- Downtown Location North Location

3. Are you an Existing Patient or New Patient? Existing Patient New Patient

4. Did our staff greet you when you arrived at the office? Yes No

5. How would you rate your overall experience with Eye Associates of Colorado Springs? Excellent Good Average Poor Very Poor 6. How would you rate your experience making your appointment with Eye Associates of Colorado Springs? Excellent Good Average Poor Very Poor 7. Please provide any feedback or suggestions you feel would allow Eye Associates of Colorado Springs to better serve our patients. 8. If you would like to write a testimonial about your visit please free to write it in the box below. 9. If you would like to put your name for your testimony please put your first name and last initial here. To prevent spam please answer this question. What is 6 - 5 plus 3?