Feedback – Benivue

Thank you for choosing us for your eye care. Kindly share your feedback to help us serve you better.

Eye Drop Instillation

1. Did you find the provided instructions on how to use your eye drops clear and easy to follow (written and/or verbal)?

Yes

2. How would you rate the ease of getting a drop into your eye?

Very Easy

Easy

Average

Difficult

Very Difficult

3. Did you experience any of the following difficulties with the eye drop bottle or application technique?

Difficulty squeezing the bottle

Difficulty opening the bottle

Too many drops coming out at once

Touching the bottle to the eye or eyelid

Difficulty with stability or hand movements

Other comments:

4. Are you able to use the eye drops at the correct frequency as prescribed by your doctor?

Always

Sometimes

Never

5. Did you have any problems with side effects that made you want to stop using the drops?

Yes

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6. Overall, how satisfied are you with your ability to manage your eye drop treatment at home?

Very Satisfied

Satisfied

Average

Unsatisfied

Very Unsatisfied

7. Would you like a member of our team to provide further one-on-one instruction or assistance with your eye drop technique?

Yes, please contact me

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No, I am all set

Any additional comments or suggestions?