About Us
Our Company
>
Who We Are
Careers
Our Doctors
>
All
Mark Kahrhoff, OD
Derek Wiles, OD
Chris Brenon, OD
John Crane, OD
Evan Williams, OD
Our Services
>
Eye Exams
Eye Glasses
Contact Lenses
Binocular Vision
Vision Therapy
Visual Neurocognitive Training
School Screenings
Myopia Control
Locations
All
Leadington
Festus
Webster Groves
Testimonials
Request an Appointment
News
Blog
Eye Care Articles
Promotions
Online Services
Check Insurance Eligibility
Patient Forms
Order Contact Lenses
Body Mass Index Calculator
Patient Portal
Contact Us
Contact Form
Satisfaction Survey
COVID-19
Satisfaction Survey
We appreciate and value your feedback.
*
Indicates required field
Name
*
First
Last
Date of Birth (mm/dd/yyyy)
*
Phone Number
*
Status
*
New
Established
Email
*
Location
*
Festus
Leadington
Webster Groves
Doctor:
*
Please make selection
Mark Kahrhoff, OD
Derek Wiles, OD
Evan Williams, OD
Christopher Brenon, OD
John Crane, OD
Unable to recall
Convenience of our office hours:
*
Excellent
Very Good
Good
Poor
N/A
Ease of making your appointment:
*
Excellent
Very Good
Good
Poor
N/A
Promptness with which you were seen by the doctor:
*
Excellent
Very Good
Good
Poor
N/A
Thoroughness of care you received:
*
Excellent
Very Good
Good
Poor
N/A
Clarity of Doctor's explanations:
*
Excellent
Very Good
Good
Poor
N/A
Doctor's friendliness and courtesy:
*
Excellent
Very Good
Good
Poor
N/A
Staff's friendliness and courtesy:
*
Excellent
Very Good
Good
Poor
N/A
Help with understanding your insurance coverage:
*
Excellent
Very Good
Good
Poor
N/A
Selection of eyeglass frames:
*
Excellent
Very Good
Good
Poor
N/A
What is/are your favorite brand(s)?
*
Knowledge/assistance of optical staff:
*
Excellent
Very Good
Good
Poor
N/A
Comfort and cleanliness of office:
*
Excellent
Very Good
Good
Poor
N/A
Overall satisfaction with your visit:
*
Excellent
Very Good
Good
Poor
N/A
Will you be returning to see us?
*
Yes
No
Undecided
Would you recommend us to others?
*
Yes
No
Undecided
Tell us about your experience.
*
How did you hear about us?
*
I agree to receiving marketing and promotional materials
Submit
About Us
Our Company
>
Who We Are
Careers
Our Doctors
>
All
Mark Kahrhoff, OD
Derek Wiles, OD
Chris Brenon, OD
John Crane, OD
Evan Williams, OD
Our Services
>
Eye Exams
Eye Glasses
Contact Lenses
Binocular Vision
Vision Therapy
Visual Neurocognitive Training
School Screenings
Myopia Control
Locations
All
Leadington
Festus
Webster Groves
Testimonials
Request an Appointment
News
Blog
Eye Care Articles
Promotions
Online Services
Check Insurance Eligibility
Patient Forms
Order Contact Lenses
Body Mass Index Calculator
Patient Portal
Contact Us
Contact Form
Satisfaction Survey
COVID-19
