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Blink Patient Feedback
Please give us your Feedback on how to best serve you!
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To authenticate our survey, please write your initials and the LAST name of your eye doctor. For example: IM, IDOC.
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Your answer
How soon do you want to schedule your eye exam?
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As soon as possible
I'd like to be seen within a week
I'd like to be seen in one month.
I'm in no hurry. Schedule me within 3 months
What time of the day would you like to schedule your appointment?
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Early morning
Late evening
Weekend
Any time is fine. I am flexible
Are you interested in getting glasses or contact lenses?
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Glasses only
Contact Lenses only
Both
Neither. I just want an eye exam
If you are getting glasses, what do you prefer?
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Get new frames.
Use my own frames
If you are getting glasses, how much would you spend?
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MORE than the last time I bought glasses
LESS than the last time I bought glasses
the SAME as the last time I bought glasses
Other:
Next time you purchase glasses, which of following options are you interested in ?
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Blue-light Block lens treatment
Anti-fog lens treatment
Polarized sunglasses
All of the above
Required
Which of the following are important to you when buying glasses? Choose your top 3.
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Convenience, one stop shop
Quality
Pricing
Variety of choices
Fashionable, Unique design
Full package, all inclusive price instead of multiple add-on pricing
Other:
Required
Are you interested in trying contact lenses?
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Yes
No
Maybe
Which one of following contact lens options are you interested in?
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Bifocal contact lenses
Contact lenses that correct my astigmatism
Contact Lenses that are 'light-activated' - changing color based on light conditions
Any Contact Lenses. I'm so tired of my glasses fogging up under my mask.
Other:
Required
Which of the following factors is important to you? Check all that applies.
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Money
Health
Faith
Family
Time
Other: please list
Tell us how you feel about your health and your vision?
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More important than before
Less important than before
The same as before.
In regards to maintaining good vision, which of the following is important to you? Check all that applies.
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Annual eye exams
Sunglasses that protect my eyes against UV.
Glasses that reduce eyestrain.
Spare / Back up Glasses.
Eye Protection (sports, hobbies, etc.)
Contact lenses instead of glasses, or as a supplement to glasses.
Other:
Required
Post Covid-19, what would be some changes you'd like to see at Blink?
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Your answer
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