We appreciate you taking the time to complete our survey. Please feel free to comment on your recent visit as well. Any comments you choose will be kept strictly confidential and can only help us become better in the future.
Patient Name:
Email Address:
Please check each item that applies to previous, current or future dental treatment.
Appointments
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
It was easy to make an appointment
The appointment secretary
was courteous and helpful
Appointment options were
given that matched my schedule
Finances and fees were explained to me
Facilities
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
Office location and parking were convenient
The reception area was neat and clean
The equipment was clean and presentable
The temperature in the office was comfortable
Staff
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
The dentist was professional
and courteous
The dental hygienist was
professional and courteous
The dental assistant was professional and courteous
Other staff was
professional and courteous
The staff was considerate
and sensitive to my needs
Treatment
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
The proposed treatment was clearly explained to me
All my questions were answered
Treatment alternatives
were given
The dental treatment was
completed in a timely and
efficient manner
I am pleased with the
quality of dental treatment
How could we make your visit more enjoyable? Comments.