Optometry Practice Patient Satisfaction Survey

Elevate Your Optometry Practice with Patient Feedback

Understanding patient satisfaction is critical for any optometry practice looking to deliver exceptional eye care. This optometry patient satisfaction survey template helps you capture detailed feedback on every touchpoint—from the thoroughness of the eye exam to prescription accuracy, frame selection assistance, and insurance handling transparency.

With this template, you can identify what's working well and where improvements are needed. Whether you're a solo optometrist or managing a multi-location practice, collecting structured feedback helps you build patient trust, improve retention, and create a better overall experience.

Designed for Optometry Practices

This survey covers the core aspects of a patient visit: appointment scheduling, wait times, staff friendliness, exam quality, optical selection support, and billing clarity. The template uses a mix of rating scales, multiple choice questions, and open-ended feedback fields to give you both quantitative metrics and qualitative insights.

Paperform makes it easy to customize the survey to match your brand, embed it on your website, or send it via email after appointments. You can even set up automations with Stepper (stepper.io) to route negative feedback alerts to management, log responses in your CRM, or trigger follow-up workflows for patients who report concerns—keeping your team responsive and proactive.

Track What Matters Most

Use this template to measure patient satisfaction across key performance indicators like exam thoroughness, prescription confidence, frame selection guidance, and insurance transparency. With AI Insights, you can quickly summarize trends across hundreds of responses, spot recurring themes, and turn feedback into actionable improvements without manually reading every submission.

Whether you're in private practice, part of a larger optical retail chain, or managing a specialty eye care clinic, this template is built to help you deliver care that patients trust and recommend.