Eye Care & Optician Visit Survey
Exam thoroughness, honest frame advice, and how the new prescription feels.
4 questions · 1 page · about 2 minutes to answer · fully editable after you start
Optical retail mixes clinical exam with commissioned sales, and patients feel the seam. This survey rates both sides separately: the eye exam's thoroughness and explanation, then the dispensing experience – whether frame and lens advice felt honest or upsold – and the follow-up question that matters clinically: how the new prescription actually feels a week in.
The prescription-feels answers catch the adaptation problems and errors that silent patients simply tolerate, wearing compromised vision until the next visit.
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Page 1
Your eye care visit
This survey is about your recent eye care appointment. Tell us how the visit and your new prescription are working for you. It takes about 2 minutes. This form is not an emergency service. If you need urgent medical help, call your local emergency number.
Q1.How would you rate each part of your visit?*
| Poor | Fair | Good | Excellent | Not applicable | |
|---|---|---|---|---|---|
| Thoroughness of the eye exam | |||||
| Explanation of your results | |||||
| Honesty of frame and lens advice | |||||
| Value for what you paid |
Q2.A week in, how does the new prescription feel?
- Great - clear and comfortable
- Still adapting
- Something seems off
- Not applicable
Q3.How pressured did you feel toward expensive options?
Q4.Anything about your vision or glasses we should follow up on?
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