Post-Cataract Surgery Feedback Questionnaire
Patient Name
Date of Surgery
Surgeon's Name
1. How would you rate your vision after surgery?
Excellent
Good
Average
Poor
2. Did you experience any of the following symptoms after surgery?
Pain
Redness
Blurry Vision
Other
3. Are you satisfied with the information provided about your surgery?
Yes
Somewhat
No
4. Was your follow-up appointment scheduled promptly?
Yes
No
5. Would you recommend this procedure to others?
Yes
No
Additional Comments