Home
Doctors
Richard L. Blount, M.D.
V. John Ford, M.D.
R. Glenn Herrington, M.D.
Robert A. Mallette, M.D.
John H. McVey, M.D.
Robert O. May, M.D.
Wilson E. Moak, M.D.
Troy M. Newman, M.D.
Grace Oh, M.D.
Philip C. Smith, M.D.
Kenneth P. Toler, Jr. M.D.
Curtis D. Whittington, M.D.
About
Services
Eye Exams
Cataract Surgery
Multifocal IOL’s
Glaucoma Treatment
Botox
Latisse
Cornea Center
Eye Injury
Pediatric Problems
Muscular Disorders
Patient Information
Downloadable Forms
Request Appointments
Prescription Refill
Patient Survey
HIPAA Policy
Eye Care
Eye Conditions
Patient Financing
Directions
Contact Us
JEA JAckson
JEA Clinton
JEA Madison
Directions
Laser Vision Center
Cataract Center
Dry Eye Center
Optical Boutique
Surgical Videos
Patient Survey
Jackson Eye Associates
Customer Satisfaction Survey
About You
1. What is your gender?
Male
Female
2. What is your ethnic origin?
African American
Asian
Caucasian
Hispanic
Native American
Other
3. What is your age?
Under 18
19-25
26-35
36-50
51-65
Over 65
4. What is your marital status?
Single
Married
Divorced
Widowed
5. How long have you been a patient at JEA?
Less than 1 year
1-2 years
3-4 years
More than 5 years
This section of the survey asks for your opinion about many different issues.
Please read each statement and choose the answer that best corresponds to your level of agreement or disagreement.
6. Telephone:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
The phone was answered by the third ring:
When I spoke to a JEA employee, they were courteous:
When I spoke to a JEA employee, they were efficient:
It did not take too long to make my appointment:
I received an appointment date and time in a reasonable amount of time:
I was not put on hold for an excessive amount of time:
The JEA employee answered all of my questions:
The JEA employee mentioned JEA Optical:
7. Waiting Area:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
The waiting room was clean:
The waiting room had current reading material:
The waiting room was well organized:
Coffee was available in the waiting area:
8. Front Desk/Check-In:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
I was greeted in a friendly manner:
The JEA staff was efficient:
The JEA staff was courteous:
The front desk staff was neat in appearance:
The front desk staff answered all of my questions:
The front desk staff satisfactorily explained all forms to me:
The front desk staff assisted me with my paperwork:
The JEA staff satisfactorily explained all my financial obilgations to the office:
The front desk staff was helpful:
The front desk staff mentioned JEA optical:
9. Clinical Staff
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
The JEA technicians were efficient:
The JEA technicians were courteous:
The JEA technicians were neat in appearance:
The JEA technician identified his or herself when I was called from the waiting room:
I did not feel rushed by the technician:
All testing that was performed was explained to me prior to the testing:
All questions I directed to the technician were answered:
The JEA technician kept all instruments and machines clean:
The technician mentioned JEA Optical:
10. Doctor
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
I had a sufficient amount of time with my doctor:
The doctor answered all of my questions:
I received a thorough examination by the doctor:
If I received any medication, its use and purpose was explained to me:
If I received treatment, the treatment and possible outcomes were explained to me:
My doctor was genuinely interested in what I said:
I did not feel rushed during my appointment:
My doctor mentioned JEA Optical:
11. Check-Out
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
I was greeted in a friendly manner.
The check-out staff explained all my financial obligations to the office:
The check-out staff was neat in appearance:
The check-out staff made my next appointment in a timely manner:
The check-out staff was courteous:
The check-out staff mentioned JEA Optical:
12. Optical
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
I was greeted cheerfully when I entered JEA Optical:
I was waited on in a timely fashion:
My glasses/contacts were ready when promised:
JEA Optical was well organized:
JEA Optical was clean:
13. General
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Applicable
I would recommend JEA and JEA Optical to others:
I will visit JEA and JEA Optical again:
Overall I was satisfied with my experience at JEA:
Overall I was satisfied with my doctor at JEA:
14. What do you like best about JEA?
15. What can we do to improve JEA?
16. Please feel free to offer any additional thoughts or comments:
17.
Doctor's name:
Date of appointment:
Optional
18.
If you would like to receive special JEA Optical discounts just for filling out this survey, please provide us with the following information:
Name:
Address:
Phone Number:
Email Address:
19. Would you like to receive quarterly newsletters, and special offers from JEA?
Yes
No
Thank you.
www.jacksoneye.com