Patient Survey

    Only Type your First Name and Last Initial (Ex. John D.)

    Your Name:

    Your City:

    Your Email:



    Please select the reason(s) for your visit below

    First visit with Dr. Hillson

    Follow-up visit with Dr. Hillson

    AMD Assessment


    Cataract Assessment

    Glaucoma Assessment

    Other Reason for Visit


    Please rate each feature of your visit on the scale below

    Wait time to get appointment

    PoorFairGoodVery GoodExcellent


    Telephone communications

    PoorFairGoodVery GoodExcellent


    Office comfort & cleanliness

    PoorFairGoodVery GoodExcellent


    Waiting time in the office

    PoorFairGoodVery GoodExcellent


    Receptionist skills
    (professionalism/politeness)

    PoorFairGoodVery GoodExcellent


    Eye Technician skills
    (professionalism/politeness)

    PoorFairGoodVery GoodExcellent


    Doctor skills
    (professionalism/politeness)

    PoorFairGoodVery GoodExcellent


    Reason for visit addressed

    PoorFairGoodVery GoodExcellent


    Amount of time spent with Doctor

    PoorFairGoodVery GoodExcellent


    Overall visit rating

    PoorFairGoodVery GoodExcellent


    Any further positive or negative comments you would like to add in the space below would be much appreciated

    THANK YOU FOR HELPING US PROVIDE THE BEST POSSIBLE SERVICE TO YOU

    At our office your satisfaction and care are our top priorities

    We strive to provide the highest standard of service, but we understand that sometimes concerns may arise. If you have a complaint or feedback about your experience, we encourage you to share it with us so we can address it promptly and improve our services.

    How to Share Your Concerns

    1.    Speak with Us Directly – Please notify any staff member, or ask to speak with the clinic manager. Many issues can be resolved quickly through open communication.

    2.    Submit in Writing – If you prefer, you may submit your complaint via email (info@visualsurgery.com) or in writing at our front desk.

    3.    Confidentiality – All complaints will be handled with discretion and in accordance with privacy laws (PHIPA in Ontario, or applicable provincial legislation).

    Our Commitment

    ·         We will acknowledge your complaint promptly (within 7 business days).

    ·         Your concern will be reviewed fairly and thoroughly.

    ·         We will work toward a resolution and keep you informed (receive a written or verbal response within 10 business days).

     

    If you are not satisfied with our response, you may contact for further guidance:

    • The College of Physicians and Surgeons of Ontario (CPSO):416-967-2600
    • The Patient Ombudsman: 416.597.0339, info@patientombudsman.ca),
    • The Canadian Medical Protective Association (CMPA): 1-800-267-6522

    We appreciate your trust in our clinic and welcome feedback to help us serve you better.

    (Note: based on the office Complaint Handling Policy, PC4, April 2025).