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  Ophthalmologists Contact Form
 
Dear Doctor, Thank you for sparing your valuable time in filling up this form. It will help us serve you better.
 
Name :  
Qualification :  
Address :  
1) Have you heard of New World iCare ?  
2) Are you aware that New World iCare
offers State -of-the Art Laser
vision correction?
 
3) Do you have LASIK Surgery facility in
your clinic?
 
4) Are you aware that New World iCare is
open to Doctors to use its facility?
 
5) Have you ever been invited to our Clinic
for a Demonstration?
 
6) Would you like to come and see the
facility at New World iCare?
 
If Yes, which day of the week and what
time would you perfer to visit?
 
7) Have you ever used our facilites?
 

If Yes then please rate your views: Rate your satisfaction level with each of the following statements.

1 = very satisfied 2 = somewhat satisfied
3 = neutral 4 = somewhat dissatisfied
5 = very dissatisfied
 
1
2
3
4
5
a) How satisfied are you with our Equipments?
b) How satisfied are you with our Centre?
c) How satisfying is the quality of our Service?
d) Rate your overall satisfaction?
 
8) Kindly give your general comments and
views to offer you better services in
the future :
 
 
 
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