Help Us Help You: Your Feedback Makes a Difference

Thank you for taking the time to complete the Ocutech Self-Assessment.

Your feedback is important to us, and we value your input. Please share your thoughts and insights by completing our brief follow-up questionnaire below.

1. Was the questionnaire easy for you to complete?(Required)

Yes

2. Was the information we provided in our report easy for you to understand?(Required)

Yes

3. Have you visited a low vision specialist after receiving our report?(Required)

Yes

4. Who did you visit?(Required)

5. Did you find your visit helpful?(Required)

Yes

6. Were you tested for an Ocutech Low Vision device?(Required)

Yes

7. Did you receive an Ocutech Low Vision device?(Required)

Yes

8. Did you receive any low vision device(s)? If yes, what? 9. Is there anything else you would like to tell us?

4. If no, why did you not visit a low vision specialist? (select all that apply).(Required)

I plan to go but haven't arranged it yet

I cannot arrange transportation

There is no low vision provider convenient to me

I am concerned that I cannot afford to visit a low vision provider

I've decided to not pursue low vision care

Another Reason

Other Reason 5. Is there anything else you would like to tell us?

Your feedback will help us continue to improve our services and support for individuals like you who are seeking enhanced vision solutions.