Step 1 of 5 20% Patient Information Survey We’re considering expanding our services and would love your feedback! Your answers will help us decide on new hours, services, and locations that work best for you and your family. Patient Location & Visit ContextWhich location do you usually visit?(Required) Downtown Chevy Chase Arlington When was your last visit?(Required) Within the past 3 months 3–6 months ago Over 1 year ago Patient Information Survey We’re considering expanding our services and would love your feedback! Your answers will help us decide on new hours, services, and locations that work best for you and your family. Saturday Hours at New LocationIf our Arlington Location offered Saturday hours, how likely would you be to book there?(Required) Very likely Somewhat likely Not likely Which Saturday time slot would you prefer? (Select all that apply)Which Saturday time slot would you prefer? (Select all that apply)(Required) Morning (8–10 AM) Mid-morning (10–12 PM) Afternoon (12–3 PM) Late afternoon (3–5 PM) Select All Patient Information Survey We’re considering expanding our services and would love your feedback! Your answers will help us decide on new hours, services, and locations that work best for you and your family. Household / Family BookingHas everyone in your household booked their eye exams for this year? We offer pediatric eye exams and services for all ages!(Required) Yes – all members are scheduled or completed No – some still need appointments No – none are scheduled yet How many people in your household typically book with us?(Required) 1 (just me) 2–3 4 or more Patient Information Survey We’re considering expanding our services and would love your feedback! Your answers will help us decide on new hours, services, and locations that work best for you and your family. Myopia Management InterestAre there children in your household under age 18 who wear glasses or contact lenses?(Required) Yes No Are you familiar with Myopia Management? Would you like more information about myopia management options (to slow the progression of nearsightedness) in your child and other valuable resources to keep your family’s vision healthy?(Required) Yes No Please enter the email address where we can contact you with more informationName(Required) First Last Email(Required)
