Survey

Thank you for visiting Derickson Vision Consultants! My staff and I are committed to providing the Greatest Experience In Eye Care available and we ask that you help us accomplish that goal. If you would take just a few moments to complete this survey, we will thank you with a $20 Gift Credit* on your account to be used for any future product or service.

We take your opinion very seriously and will make every effort to enhance the things we do well and correct the things we don't. 

Thank You for your patronage, Dr. John Derickson

Please answer the following questions in comparison with your previous experience with other health care offices:

5 – Excellent: Far exceeding most Doctor's offices I have encountered
4 – Good: Better than most
3 – Fair: Equivalent to most
2 – Poor: Worse than most
1 – N/A: Does not apply


*Credit will be given on account for use on future purchases/fees - limit one credit per year per household. PLEAS ANSWER ALL QUESTIONS TO RECEIVE CREDIT

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Contact Lenses (if you were not fit with contacts, skip this section)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Eye Wear, Sun Glasses & other Optical Products

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Overall Experience

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Who should receive the $20 credit?