Thank you for taking the time to complete this short survey, it should take you 2-5 minutes to complete and will help us improve our service for everyone.

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* 1. How did you travel to the clinic today?

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* 2. Was this your first choice of transport?

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* 3. What was the length of time between when you were referred and your appointment at the clinic?

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* 4. Were you given clear information about the following?

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* 5. Did you find the waiting room conditions comfortable?

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* 6. Did you have to wait past the time of your appointment to be seen?

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* 7. Did you find that the healthcare staff you saw were...

  Yes, completely Yes, to some extent No
Helpful
Friendly
Respectful

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* 8. Were you given any of the following information during your appointment?

  Yes No, but I would have liked it No, and I did not need it
An explanation of what the staff member was going to do
Details of any follow-up treatment or medicines
Information about how you can look after your eyes

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* 9. Were any questions you had, answered in a satisfactory manner?

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* 10. How long did your appointment take?

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* 11. Were you given any printed information to take away with you?

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* 12. Did your appointment meet your expectations?

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* 13. If you would like to make any further comments about your visit to the clinic please do so below

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* 14. When were you seen in the service?

Date

T