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Customer Survey

At the Eye Boutique, we really value you as a patient and want to hear how we can best serve you and your family.

When you complete the questions below and click submit, you will receive a $5 coupon to use on your next visit. The coupon is good toward a wide range of eyewear accessories such as eyeglass chains, cleaning cloths, contact lens cleaning solutions, etc.

It is just our way of saying thank you! for helping us serve you better!

 

1. Which Eye Boutique location did you visit?
Schaumburg Algonquin Crystal Lake
Joliet Naperville Geneva

Date of visit:

 
2. Why did you choose The Eye Boutique? (select all that apply)
Referred by health professional Yellow Pages Insurance
Referred by friend Advertising Website
Saw clinic from the road
 
3. How easy did we make it for you to schedule a convenient appointment?
Exceptional Good Average Below Average
 
Please tell us why: (optional -- greatly appreciated)
 
4. How would you rate your experience with our Eye Doctor?
Exceptional Good Average Below Average

Doctor's Name: (optional)


Please tell us why: (optional -- greatly appreciated)
 
5. How would you rate your experience with our optician?
Exceptional Good Average Below Average

Optician's Name: (optional)


Please tell us why: (optional -- greatly appreciated)
 
6. If you were trying to access insurance benefits, were we helpful?
Exceptional Good Average Below Average
 
Please tell us why: (optional -- greatly appreciated)
 
7. How would you rate your overall experience At The Eye Boutique?
Exceptional Good Average Below Average
 
Please tell us why: (optional -- greatly appreciated)
 
8. Would you recommend Eye Boutique to your family & friends?
Yes No
 
Why or Why Not?
 
If you'd like us to contact you, please include the following information.
   
Name:
Email:
Daytime Phone: