Patient Survey

 
In order to serve you better please feel free to give us some feedback on how we’re doing with fulfilling your desires and making you happy, and with the treatment you’ve received. Thank you for your time in improving our attentiveness and relentless attention to quality delivery of care.
 
Services received:






 
Appointment Date:    Appointment Time:   
 
1) Cleanliness of facility
2) Equipment modernity
3) Comfort of reception area
4) Wait time
5) Receptionist attention to your needs
6) Receptionist friendliness
7) Receptionist professionalism
8) Hygienist attention to your needs
9) Hygienist friendliness
10) Hygienist professionalism
11) Hygienist oral hygiene education level
12) Chairside assistant attention to your needs
13) Chairside assistant friendliness
14) Chairside assistant professionalism
15) Chairside assistant treatment education level
16) Doctor attention to your needs
17) Doctor friendliness
18) Doctor professionalism
19) Teamwork
20) Explanation of treatment options
21) Length of time to get appointment
22) Availability of payment options
23) Convenience of hours
24) Thoroughness of exam
25) Thoroughness of treatment
26) Level of comfort during treatment
27) Overall rating of care
28) Likelihood to refer us to friends
 
Additional Comments: