office evaluation form
Perrysburg office
Zysik and Zysik, LLC

We would appreciate your assistance in completing the following evaluation form in order to better serve your eye care needs.

Please rate us according to the following scale:

Scale:
SD - Strongly Disagree
D - Disagree
N - Neutral
A - Agree
SA - Strongly Agree
1. Which doctor did you see?

 

2. It was easy to schedule an appointment at a convenient time.

SD     D     N     A     SA

3. The staff answered my questions in a knowledgeable manner.

SD     D     N     A     SA

4. The staff was courteous and helpful.

SD     D     N     A     SA

5. My waiting time in the office was reasonable.

SD     D     N     A     SA

6. My examination was thorough.

SD     D     N     A     SA
7. I was satisfied with the doctor's explanation of my visual conditions and treatment options.

SD     D     N     A     SA
8. I was satisfied with the quality of the services and products I received.

SD     D     N     A     SA
9. Eyewear and lens design choices were well communicated.

SD     D     N     A     SA
10. The services and products I received were a good value.

SD     D     N     A     SA
11. I would recommend your office to my family and friends.

SD     D     N     A     SA

Please make specific comments about the staff or doctors here.
What improvements do we need to make?
Name (optional):
©2004; Pinnacle Eye Group, LTD. All rights reserved.