SURVEY FORM

Respondents! We are the proponents of the research entitled “The Visual Acuity and Recognized
Speech System”, from Lyceum of the Philippines University - Cavite Campus. We humbly ask for
your consideration in answering this survey form honestly. Thank you!
Part 1. Respondent’s Profile
Instruction: Fill-up the blank with the right answer.
Name (Optional): _______________________________ Age: _______ Gender: ________
Part 2. Prototype Quality Characteristics
Instruction. Kindly mark a check (✔) as you rate each item to extent that the device displays the
following traits and behavior using the following scale.
Legend:
5 - Strongly Agree 4 – Agree 3 - Slightly Agree 2 – Disagree 1 - Strongly Disagree
Functionality 1 2 3 4 5
1. The main device connects with the Monitor and Microphone. ✔
2. The monitor displays the letters of each line of the eye chart
✔
accurately.
3. The voice of the patient is recognized by the microphone. ✔
4. The recognized voice of the patient is processed as an answer
✔
by the device.
5. The thermal printer prints the test result of the patient correctly. ✔
Usability 1 2 3 4 5
1. The device is comfortable and easy to use. ✔
2. The device can be learned easily. ✔
3. The device is beneficial to the patients. ✔
4. The device is safe to use. ✔
5. The visual components of the device are simple and pleasing. ✔
6. The visual components of the device are easy to understand. ✔
Efficiency 1 2 3 4 5
1. The Visual Acuity test can easily be taken using the device. ✔
2. The device can project the letters effortlessly. ✔
3. The results can be seen right after the Visual Acuity Test. ✔
4. The device can measure Visual Acuity quickly. ✔
5. The voice of the patient was instantly received by the device. ✔

Validated by:
6/12/21
__________________________
Aldren B. Narzoles
LPU-C/COECSA