Patient Survey

• Are you:

  • Male
  • Female
• Age: 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+
• What industry do you work in? Clerical/Administrative Computer Technology/IT/MIS Construction/Facilities Customer Service Health Care (doctor, nurse, aide, therapist, etc.) Industrial/Manufacturing Law enforcement, EMS or firefighter Legal Military Other Professional/Management Restaurant/Hospitality Sales Sports & Entertainment Teacher/Education Transportation/Logistics
• How long ago did you have LASIK? Within the last 3 months Within the last 6 months Within the past year More than 1 year ago More than 3 year ago
• How many people do you believe you have referred to LasikPlus®? 0 1 2-3 4-6 7-10 10+
• Approximately when did you refer most people to LasikPlus®? 3 months after procedure 3 + months after procedure Consistently spread out since procedure
• Who have you referred to LasikPlus®? Check all that apply.
  • Friends
  • Family
  • Work colleagues
  • Neighbors
  • Online
  • People I know through hobbies, interests, professional organizations
• What is your most frequent way of referring others to LasikPlus®? Face to face By phone IM Email Text Messaging Online communication Blog
• What about your LASIK experience are you asked about most?
• How could we keep you “spreading the word” about your LasikPlus® experience?