Scripps Poway Orthodontics Customer Satisfaction Survey

Scripps Poway Orthodontics Customer Satisfaction Survey

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1. Default Section

1. Appearance of Office

	1 Terrible	2	3	4	5 Great Appearance
Please rate the appearance of the office.	Appearance of Office Please rate the appearance of the office. 1 Terrible	2	3	4	5 Great Appearance

Additional Comment

2. Wait time

	1 Never wait	2	3	4	5 Always wait 30 min or more
How would you rate our wait time in the reception area	Wait time How would you rate our wait time in the reception area 1 Never wait	2	3	4	5 Always wait 30 min or more

Comments

3. Location, please rate the convenience of:

	1 Very Inconvenient	2	3	4	5 Convenient
Parking	Location, please rate the convenience of: Parking 1 Very Inconvenient	2	3	4	5 Convenient
Location in strip mall	Location in strip mall 1 Very Inconvenient	2	3	4	5 Convenient
General Location in San Diego	General Location in San Diego 1 Very Inconvenient	2	3	4	5 Convenient

Additional Comment

4. Please rate Dr. Maulik's explanation of treatment 1-10 (10 being best). 1 = Had several unanswered questions, did not know what was going on at all.
10 = Had no additional questions, completely understand what is going on

	1	2	3	4	5	6	7	8	9	10
How well are your questions answered by Dr. Maulik?	Please rate Dr. Maulik's explanation of treatment 1-10 (10 being best). 1 = Had several unanswered questions, did not know what was going on at all. 10 = Had no additional questions, completely understand what is going on How well are your questions answered by Dr. Maulik? 1	2	3	4	5	6	7	8	9	10

Additional Comment

5. Schedule

	1 Extremely Inconvenient	2	3	4	5	6	7	8	9	10 Completely Convenient
Please rate how you feel about the appointment times available.	Schedule Please rate how you feel about the appointment times available. 1 Extremely Inconvenient	2	3	4	5	6	7	8	9	10 Completely Convenient

Additional Comment

6. On a scale of 1-5 (5 being best) how would you rate the assistants

	1	2	3	4	5
Professionalism	On a scale of 1-5 (5 being best) how would you rate the assistants Professionalism 1	2	3	4	5
Experience	Experience 1	2	3	4	5
Friendliness	Friendliness 1	2	3	4	5
Gentleness	Gentleness 1	2	3	4	5
Timeliness	Timeliness 1	2	3	4	5

Additional Comment

7. Contract

	1 Did not undertand the contract at all	2	3	4	5 Completely understood the contract
How well was the contract explained to you?	Contract How well was the contract explained to you? 1 Did not undertand the contract at all	2	3	4	5 Completely understood the contract

Additional Comment

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