New Opticians Customer Survey Form

Customer Survey Form
Lexington, VA 24450

Let us know what you think of our services!

Your Information
Your Name (Optional):
Email Address (Optional)
Do you wear bifocals?	Yes No
Do you wear Contacts?	Yes No
Do you wear Prescription sunglasses?	Yes No
How many pair of prescription glasses do you keep with your current prescription?	One Two More...
Why did you select New Opticians?	Previous Customer Relative/Friend Yellow Pages Newspaper Radio Other
How would you rate The New Opticians?
Prescription Assistance	Excellent Good Fair Poor
Frame Assistance	Excellent Good Fair Poor
Professional Knowledge	Excellent Good Fair Poor
Service	Excellent Good Fair Poor
Cost	Excellent Good Fair Poor
Quality	Excellent Good Fair Poor
What is most important to you in eyewear selection?	Speed Professional Assistance Style Accuracy Cost
What do you expect the cost of your next eyewear to be?	0-$200 $200-$400 $400 and up