At the Family Vision Clinic we're interested to hear about your experience with us.  Please spend a moment and share.

All valid entries will be entered into our quarterly drawing for a $100 gift card good towards an eyewear purchase!*

Location:  Savage         Farmington

Doctor:  Hurst         Rupnow        Sculley         N/A

1) Was your time well spent at our office?   Yes         No

2) Do you feel the information provided to you was clear and concise?    Yes        No

3) Would you refer a friend to our clinic?    Yes          No

4) How did you hear about us?

         Search Engine     Insurance      Advertisement       Friend      Other

Do you have any recommendations or general comments that could improve the performance of our office?

Check here if you like to be contacted for any specific questions or concerns:

Please provide the following contact information so we can contact you for any questions/concerns.  All information is kept strictly confidential.

First Name
Last Name
Home Phone
E-mail

Check here if you would be willing to let us post your feedback on our testimonial page:

EXTRA CREDIT...  Submit feedback via Yelp (Savage - Farmington); Twincities.Citysearch (Savage - Farmington), Yahoo (Savage - Farmington) or Google (Savage - Farmington) and if your entry is drawn we'll increase the prize to $150! Simply click on one (or all) of the above links and provide a review. Then, enter your username(s) here:

*valid on prescription or non-prescription glasses or sunglasses