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Grand Strand Vision Therapy Survey
We would appreciate feedback from our patients and/or parents regarding our Vision Therapy services. Please take a few minutes to answer these short questions. Thank you!
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* Indicates required question
How recently have we provided you services?
*
Currently receiving services
Within the past 6 months we received services
More than 6 months but less than 2 years ago
Prior to 2020
Did you see improvement with the program of care you received at Grand Strand Vision Therapy?
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Yes
No
Has your quality of life improved in any of these areas? (Select all that apply)
*
Academics (reading ability, grades increased, completion of work)
Personal (happiness/contentment, confidence, self-worth)
Activities (sports, hobbies, digital devices/electronics)
Behavior (more focused/engaged, better moods/social skills, less complaints/disruptions and/or avoidance)
Physical (fewer headaches/body complaints, less motion sickness, appearance of eyes, eye strain/fatigue)
No Change
Required
Of these improvements, what was the most important and meaningful to you? Why?
*
Your answer
Did you attend a workshop prior to receiving services or would you have attended an after-hours workshop with Dr. Dean to learn about vision and how it affects your (your child’s) learning, reading, attention, or behavior?
*
Yes, I attended a workshop.
No, a workshop was not offered.
If a workshop had been offered, I would have attended.
I chose not to attend a workshop that was offered.
I would not have attended an after hours workshop. My questions were answered by the staff.
Please rate on a Scale of 1 to 5 the "Friendliness of staff" overall during your visits.
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Low
1
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4
5
High
Please rate on a Scale of 1 to 5 the overall "appearance of the GSVS office facilities" during your visits. (waiting room, exam room, therapy room, etc.)
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Low
1
2
3
4
5
High
Please rate on a Scale of 1 to 5 the overall "ease of scheduling appointments" with GSVS.
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Low
1
2
3
4
5
High
Please rate on a Scale of 1 to 5 the "cleanliness of office and rooms" at GSVS during your visits.
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Low
1
2
3
4
5
High
Please rate on a Scale of 1 to 5 your expectations "prior" to Vision Therapy services provided by GSVS.
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Low
1
2
3
4
5
High
Please rate on a Scale of 1 to 5 how well your "expectations were met" after GSVS services were provided.
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Low
1
2
3
4
5
High
We value your feedback. Please share any constructive comments or suggestions to improve our office or praises for our staff.
Your answer
Share your success story!!! If you are willing to share your GSVS success story (or your child's) with other patients who are discovering vision therapy, please include below. (*Any stories would be posted anonymously. Please call the office at #843-293-1555 if you are willing to share your name and/or photo. We have a new media release form.) Thanks!
Your answer
Optional: Name & Email
Your answer
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