Upper Montclair Eye Care & Wear
Bringing Your World Into Focus

Dr. Saras Rustagi | Lic #270A005845 | Cert# 27OM500052603

Survey

Service Ratings
Communication prior to appointment
Great Good Fair Poor N/A
Appointment availability
Great Good Fair Poor N/A
Waiting room time
Great Good Fair Poor N/A
Fees
Great Good Fair Poor N/A
Quality of care from doctor
Great Good Fair Poor N/A
Concerns or questions answered (eye exam)
Great Good Fair Poor N/A
Concerns or questions answered (optical staff)
Great Good Fair Poor N/A
Overall quality of care
Great Good Fair Poor N/A
Scheduling
Preferred day for appointments
Preferred time for appointments
Do you plan on returning for your next comprehensive examination?
Yes No
If no, please tell us why not
Would you schedule appointments online?
Yes No
Products
Satisfaction with eyeglasses
Great Good Fair Poor N/A
Satisfaction with contact lenses
Great Good Fair Poor N/A
Range of eyeglasses selection
Identification (Optional)
Why did you choose us for your eye health care?
Name
Comments

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