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Patient Survey

1. Please indicate which clinic you visited:
Aloha
Newberg
Seaside
Good Samaritan
Providence-Portland
Tillamook
Gresham
St. Vincent
Lake Oswego
Tualatin-Meridian Park
2. Your Physician:
Martin Balish, MD
Jeffrey Garrett, OD
Shari Mace, OD
Brenda Stone, OD
Jacqueline Ng, MD
Daniel Brown, MD
Kelly Chung, MD
Devin Gattey, MD
Dinelli Monson, MD
Vasiliki Stoumbos, MD
Eric Brown, OD
Thomas Crawford, MD
Grant Lindquist, MD
Christen Richard, MD
Ranjana Chauhan, MD
Hugh Brumley, OD
Timothy Denman, MD
Jennifer Lyons, MD
Kevin Riedel, 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 staff courteous and helpful?

Yes No

Additional comments (optional):
5. When you arrived at your appointment, did you find the clinic facility pleasant and comfortable?

Yes No

Additional comments (optional):
6. Do you find our reception staff courteous, helpful and professional?

Yes No

Additional comments (optional):
7. Was the Technician (assistant to the physician) thorough and professional?

Yes No N/A

Additional comments (optional):
8. Do you feel the doctor addressed your concerns?

Yes No

Additional comments (optional):
9. Was the doctor courteous and professional?

Yes No

Additional comments (optional):
10. Was the staff in The Sight Shop (our onsite optical shop) professional and helpful?

Yes No N/A

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 N/A

Additional comments (optional):
13. On a scale of 1 (Dissatisfied) - 5 (Extremely Satisfied), how satisfied are you with your overall experience during your visit?
1
2
3
4
5
14. Are there any staff members in particular you'd like to recognize?

We encourage you to provide any additional comments about your experience below:

Thank you for 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.


Yes! Oregon Eye Specialists may contact me in the future via email for surveys, feedback and promotions.
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TESTIMONIAL

Whether you’re choosing the right eye care provider or deciding on a procedure, the choice is important. Testimonials from our patients offer real-life experiences for those seeking additional information and support. Not only is your testimonial the greatest compliment we could ever ask for, it is an invaluable gift to future patients.

If you feel you've made the right choice at Oregon Eye Specialists, we invite you to share your experiences with others. Please complete the form below, and be sure to check the boxes indicating how Oregon Eye Specialists may use your story!

Oregon Eye Specialists, PC has my permission to use my name, photograph, voice, likeness, profile, testimonial and/or story in any publications, presentations, web pages, print, radio, TV, and any other promotional and advertising materials produced or used by and representing Oregon Eye Specialists, PC. I understand the circulation of the material could be used world-wide and that there will be no compensation to me for this use.
I accept use in the following forms (please check ALL that you accept):
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I am willing to speak directly with other patients considering the same procedure/treatment and seeking a reference.
My full name and city of residence can be used.
Please limit use to my first name only.
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