ACCESSIBILITY

Online Survey

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.