Family Eyecare of Roswell, Dr. Maurice E. Zadeh Online Survey

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Family Eyecare of Roswell
Dr. Maurice E. Zadeh & Associates

1425 Market Blvd. Ste 315
Roswell, GA 30076
PH 770-992-6789
FX 770-462-6789

What is Custom Lasik

What is Ortho-K

You can order
your new or replacement
contacts online
24 hours 7 days a week
To Order Contacts
Click Here

Now available at Family
Eyecare of Roswell.
GDx™Precise RNFL
analysis for glaucoma
state of the art
equipment which is
considered the gold
standard in early
detection of Glaucoma.
For more detail
Click Here

Family Eyecare Of Roswell
1425 Market Blvd, Ste. 315, Roswell, GA - 30076
Phone. 770-992-6789 Fax. 770-640-6789

Family Eyecare of Roswell
Office Evaluation Card

"Eyecare That Sets You Apart From The Rest"

It was great seeing you at your last appointment. Our mission is to provide you with
the absolute best vision and eye care possible. Your feedback is very important to
us and we appreciate you taking a moment to help us enhance our service by
filling out our short survey.

Dr. Maurice Zadeh & Staff

PS. As an incentive to completing the survey, every patient that
fills out the survey, receives a $10 gift certificate from Family
Eyecare of Roswell!

We would appreciate your assistance in completing the following questions, to help us better serve your eye care
needs. Mark the box next to your answ

2 = Delighted

3= Neither Disappointed nor Delighted

Was our staff courteous and helpful?

1 = Very Delighted

4=Disappointed

5=Very Disappointed

3= Neither Disappointed nor Delighted

2= Delighted

Were you seen in a timely manner?

1= Very Delighted

4=Disappointed

5=Very Disappointed

Was your examination thorough?

1= Very Delighted

3= Neither Disappointed nor Delighted

2= Delighted

4=Disappointed

5=Very Disappointed

Were you satisfied with the explanation of your visual conditions and treatment options?

1 =Very Delighted

3= Neither Disappointed nor Delighted

4=Disappointed

5=Very Disappointed

2= Delighted

If fit with contact lenses or glasses, did the service and quality meet your expectations?

1 =Very Delighted

2= Delighted

3= Neither Disappointed nor Delighted

4=Disappointed

5=Very Disappointed

Would you refer a friend to our office for eye care?

Yes

How would you rate your overall satisfaction with our office? ( 10= Excellent 1 = Poor)

Please mention at least one aspect of our services that we could improve upon:

Other Comments:

* Required field

First name:

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