Giving Sight Day Results

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for participating in the third annual Giving Sight Day.

Please complete one form per clinic.

Email *

Clinic Name

Doctor Name(s)

City

How many patients did your clinic serve during Giving Sight Day?

What is the estimated cost of services you provided in free examinations?

If you had to turn away patients, did you provide vouches or similar for future appointments?

Yes

Other:

Clear selection

How many glasses did you provide during Giving Sight Day? Leave blank if you did not provide glasses.

What is the estimated cost of goods you provided in free or discounted glasses? Leave blank if you did not provide glasses.

Did you participate during the scheduled event on Saturday, October 1 from 9 AM to 2 PM? If not, please specify your date and time.

Yes

Other:

Clear selection

Did you require appointments or did you serve first come?

Required appointment in advance

First come & patients waited at clinic for their exam

First come but patients were provided a time slot to come back

Clear selection

Did you have an application process for a free eye exam?

Yes, in advance

Yes, on-site

Clear selection

Did you use the OAOP's Giving Sight Day campaign resources and materials, including social media content, graphics, template press release or other items?

Yes

Maybe

Clear selection

Will you consider participating in the 2023 Giving Sight Day?

Yes

Maybe

Clear selection

Do you have any additional feedback about the program or ways we can do better for next year?

Do you have a patient testimonial that you would like to share?

Yes

Clear selection

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms