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Patient Survey

1. Please indicate which clinic you visited:
Aloha
Newberg
Good Samaritan
Providence-Portland
Gresham
St. Vincent
Lake Grove
Tualatin-Meridian Park
2. Your Physician:
Martin Balish, MD
Thomas Crawford, MD
Grant Lindquist, MD
Eric Brown, OD
Daniel Brown, MD
Joseph Denman, MD
Jennifer Lyons, MD
Hugh Brumley, OD
James Cech, MD
Timothy Denman, MD
Christen Richard, MD
Jeffrey Garrett, OD
Kelly Chung, MD
David Larson, MD
Vasiliki Stoumbos, MD
Shari Mace, OD
3. Were you able to easily reach our clinic by phone?

Yes
No
Additional comments (optional):
4. When you called to make an appointment, was the clinic staff helpful and courteous?

Yes
No
Additional comments (optional):
5. When you arrived at your appt, did you find the reception area pleasant and comfortable?

Yes
No
Additional comments (optional):
6. Was the reception staff courteous and helpful?

Yes
No
Additional comments (optional):
7. Do you find our reception staff professional in appearance, manner and dress?

Yes
No
Additional comments (optional):
8. Was the Technician (assistant to the physician) thorough, professional and helpful?

Yes
No
Additional comments (optional):
9. Do you feel the doctor was interested in you and your medical problem?

Yes
No
Additional comments (optional):
10. Was the staff in The Sight Shop (our onsite optical shop) thorough, professional and helpful?

Yes
No
Additional comments (optional):
11. Would you, or have you ever, recommended Oregon Eye Specialists to your friends or family?

Yes
No
Additional comments (optional):
12. Would you, or have you ever, recommended The Sight Shop to your friends or family?

Yes
No
Additional comments (optional):
13. On a scale of 1 (Dissatisfied) - 4 (Completely Satisfied), how satisfied are you with your overall experience during your visit?
1
2
3
4
We encourage you to provide any additional comments about your experience below:

We greatly appreciate you taking a few minutes to help us evaluate our practice. As a valued patient, your feedback is very important to us and our efforts in providing the finest quality of comprehensive eye care. Thank you!

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