World Eyeglasses & Personal EyeCare

www.WorldEyeGlasses.com

6201 N. Federal Hwy, Fort Lauderdale, Florida 33308 (ON FEDERAL HWY. Between Commercial & Atlantic Blvd.- In SAME Plaza as OUTBACK & SUBWAY)

About Dr. Gary Enker
Owner & Board Certified Optometrist

World Eyeglasses & Personal Eyecare
www.WorldEyeGlasses.com
Serving Fort Lauderdale, Florida Since 1991!

6201 N. Federal Hwy Fort Lauderdale,
33308 (ON Federal Hwy Between Commercial & Atlantic Blvd.- In Same Plaza as OUTBACK & SUBWAY)
954-491-7141

Visit AllAboutVision.com for guides to glasses and contacts, and to learn about eye health topics such as cataracts and glaucoma

You may Also Print & Fax ( Fax #: 954-491-7164 )

Patient Care Evaluation Form

Please take a few seconds to complete this evaluation. We greatly appreciate your feedback and will use this information to better serve your eye care needs

First Name

Last Name

Was our staff courteous and helpful?

Yes
No
N/A

Were you seen in a timely manner?

Yes
No
N/A

Was your examination thorough?

Yes
No
N/A

Were you satisfied with your visual condition & treatment options explanations?

Yes
No
N/A

Did our contact lens/eyeglasses service & quality meet your expectations?

Yes
No
N/A

Will you refer others to our office for their eye care?

Yes
No
N/A

-------------------------------------------

Please rate your overall satisfaction with our office. (5= exceeded expectations, 1= very dissatisfied)

5
4
3
2
1

OTHER INFORMATION - You may elaborate on any information below, and/or in the office

Additional Information:

Joomla Professional Work