Patient Satisfaction Survey

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1. How long have you received care from Dr. Knight?

How long have you received care from Dr. Knight? New Patient

Patient for less than 1 year

Patient for 1-5 years

Patient for 5+ years

Other (please specify)

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2. Professional Care

	Excellent	Good	Fair	Poor	Very Poor	N/A
Adequate precautions were taken to protect me from the spread of infectious disease	*Professional Care Adequate precautions were taken to protect me from the spread of infectious disease Excellent	Adequate precautions were taken to protect me from the spread of infectious disease Good	Adequate precautions were taken to protect me from the spread of infectious disease Fair	Adequate precautions were taken to protect me from the spread of infectious disease Poor	Adequate precautions were taken to protect me from the spread of infectious disease Very Poor	Adequate precautions were taken to protect me from the spread of infectious disease N/A
Courtesy and efficiency of receptionist	Courtesy and efficiency of receptionist Excellent	Courtesy and efficiency of receptionist Good	Courtesy and efficiency of receptionist Fair	Courtesy and efficiency of receptionist Poor	Courtesy and efficiency of receptionist Very Poor	Courtesy and efficiency of receptionist N/A
Friendliness of receptionist	Friendliness of receptionist Excellent	Friendliness of receptionist Good	Friendliness of receptionist Fair	Friendliness of receptionist Poor	Friendliness of receptionist Very Poor	Friendliness of receptionist N/A
Assistant or Hygienist concern for your comfort	Assistant or Hygienist concern for your comfort Excellent	Assistant or Hygienist concern for your comfort Good	Assistant or Hygienist concern for your comfort Fair	Assistant or Hygienist concern for your comfort Poor	Assistant or Hygienist concern for your comfort Very Poor	Assistant or Hygienist concern for your comfort N/A
Concern for your privacy and safety	Concern for your privacy and safety Excellent	Concern for your privacy and safety Good	Concern for your privacy and safety Fair	Concern for your privacy and safety Poor	Concern for your privacy and safety Very Poor	Concern for your privacy and safety N/A
Attention to pain management	Attention to pain management Excellent	Attention to pain management Good	Attention to pain management Fair	Attention to pain management Poor	Attention to pain management Very Poor	Attention to pain management N/A
Your confidence in the skill of the staff	Your confidence in the skill of the staff Excellent	Your confidence in the skill of the staff Good	Your confidence in the skill of the staff Fair	Your confidence in the skill of the staff Poor	Your confidence in the skill of the staff Very Poor	Your confidence in the skill of the staff N/A
Your confidence in the skill of the doctor	Your confidence in the skill of the doctor Excellent	Your confidence in the skill of the doctor Good	Your confidence in the skill of the doctor Fair	Your confidence in the skill of the doctor Poor	Your confidence in the skill of the doctor Very Poor	Your confidence in the skill of the doctor N/A

Other (please specify)

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3. Quality of Information Received

	Excellent	Good	Fair	Poor	Very Poor	N/A
Treatment procedures (including alternatives, risks and treatment fees) were explained to me	*Quality of Information Received Treatment procedures (including alternatives, risks and treatment fees) were explained to me Excellent	Treatment procedures (including alternatives, risks and treatment fees) were explained to me Good	Treatment procedures (including alternatives, risks and treatment fees) were explained to me Fair	Treatment procedures (including alternatives, risks and treatment fees) were explained to me Poor	Treatment procedures (including alternatives, risks and treatment fees) were explained to me Very Poor	Treatment procedures (including alternatives, risks and treatment fees) were explained to me N/A
Pre-Operatively: when to arrive and how to prepare	Pre-Operatively: when to arrive and how to prepare Excellent	Pre-Operatively: when to arrive and how to prepare Good	Pre-Operatively: when to arrive and how to prepare Fair	Pre-Operatively: when to arrive and how to prepare Poor	Pre-Operatively: when to arrive and how to prepare Very Poor	Pre-Operatively: when to arrive and how to prepare N/A
Financial questions answered appropriately	Financial questions answered appropriately Excellent	Financial questions answered appropriately Good	Financial questions answered appropriately Fair	Financial questions answered appropriately Poor	Financial questions answered appropriately Very Poor	Financial questions answered appropriately N/A
Insurance questions answered appropriately	Insurance questions answered appropriately Excellent	Insurance questions answered appropriately Good	Insurance questions answered appropriately Fair	Insurance questions answered appropriately Poor	Insurance questions answered appropriately Very Poor	Insurance questions answered appropriately N/A
Discharge Instructions from staff	Discharge Instructions from staff Excellent	Discharge Instructions from staff Good	Discharge Instructions from staff Fair	Discharge Instructions from staff Poor	Discharge Instructions from staff Very Poor	Discharge Instructions from staff N/A
Information provided about delays, if any, to you	Information provided about delays, if any, to you Excellent	Information provided about delays, if any, to you Good	Information provided about delays, if any, to you Fair	Information provided about delays, if any, to you Poor	Information provided about delays, if any, to you Very Poor	Information provided about delays, if any, to you N/A

Other (please specify)

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4. Overall Assessment

	Excellent	Good	Fair	Poor	Very Poor	N/A
Response to questions/concerns/complaints	*Overall Assessment Response to questions/concerns/complaints Excellent	Response to questions/concerns/complaints Good	Response to questions/concerns/complaints Fair	Response to questions/concerns/complaints Poor	Response to questions/concerns/complaints Very Poor	Response to questions/concerns/complaints N/A
Cleanliness of office	Cleanliness of office Excellent	Cleanliness of office Good	Cleanliness of office Fair	Cleanliness of office Poor	Cleanliness of office Very Poor	Cleanliness of office N/A
Overall satisfaction with care received	Overall satisfaction with care received Excellent	Overall satisfaction with care received Good	Overall satisfaction with care received Fair	Overall satisfaction with care received Poor	Overall satisfaction with care received Very Poor	Overall satisfaction with care received N/A
Likelihood of recommending our office to others	Likelihood of recommending our office to others Excellent	Likelihood of recommending our office to others Good	Likelihood of recommending our office to others Fair	Likelihood of recommending our office to others Poor	Likelihood of recommending our office to others Very Poor	Likelihood of recommending our office to others N/A

Other (please specify)

5. What are we doing especially well?

What are we doing especially well?

6. What can we do to improve?

What can we do to improve?

7. Was there a staff member who was particularly caring and helpful you would like to thank?

Was there a staff member who was particularly caring and helpful you would like to thank?

8. Was there a staff member who needs to address a matter not addressed to your satisfaction at your visit?

Was there a staff member who needs to address a matter not addressed to your satisfaction at your visit?

9. Would you like us to personally respond regarding the actions we are taking regarding your feedback?

Would you like us to personally respond regarding the actions we are taking regarding your feedback? Yes

Other (please specify)

10. We at Richard B. Knight, DMD, PC are committed to providing you with excellent service and patient care. To this end, we are continually striving to improve the service we provide. Thank you for taking the time to complete this survey.

Please provide us with your name, if you so desire.

We at Richard B. Knight, DMD, PC are committed to providing you with excellent service and patient care. To this end, we are continually striving to improve the service we provide. Thank you for taking the time to complete this survey. Please provide us with your name, if you so desire.

Patient Satisfaction Survey
Exit this survey

1. Default Section

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1. How long have you received care from Dr. Knight?

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2. Professional Care

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3. Quality of Information Received

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4. Overall Assessment

5. What are we doing especially well?

6. What can we do to improve?

7. Was there a staff member who was particularly caring and helpful you would like to thank?

8. Was there a staff member who needs to address a matter not addressed to your satisfaction at your visit?

9. Would you like us to personally respond regarding the actions we are taking regarding your feedback?

10. We at Richard B. Knight, DMD, PC are committed to providing you with excellent service and patient care. To this end, we are continually striving to improve the service we provide. Thank you for taking the time to complete this survey.

Please provide us with your name, if you so desire.

Patient Satisfaction SurveyExit this survey

1. Default Section

*1. How long have you received care from Dr. Knight?

*2. Professional Care

*3. Quality of Information Received

*4. Overall Assessment

5. What are we doing especially well?

6. What can we do to improve?

7. Was there a staff member who was particularly caring and helpful you would like to thank?

8. Was there a staff member who needs to address a matter not addressed to your satisfaction at your visit?

9. Would you like us to personally respond regarding the actions we are taking regarding your feedback?

10. We at Richard B. Knight, DMD, PC are committed to providing you with excellent service and patient care. To this end, we are continually striving to improve the service we provide. Thank you for taking the time to complete this survey.Please provide us with your name, if you so desire.

Patient Satisfaction Survey
Exit this survey

*
1. How long have you received care from Dr. Knight?

*
2. Professional Care

*
3. Quality of Information Received

*
4. Overall Assessment

10. We at Richard B. Knight, DMD, PC are committed to providing you with excellent service and patient care. To this end, we are continually striving to improve the service we provide. Thank you for taking the time to complete this survey.

Please provide us with your name, if you so desire.