Patient Satisfaction Survey

1. Campus Commons Periodontics - Patient Satisfaction Survey

Please help us improve the quality of our services by taking a moment to complete this questionaire.

1. Did we call in advance to confirm your appointment?

Did we call in advance to confirm your appointment? Yes

2. How long did you wait in the reception area prior to being brought into the clinical area?

How long did you wait in the reception area prior to being brought into the clinical area?

3. Why were you coming to Campus Commons Periodontics?

Why were you coming to Campus Commons Periodontics? New Patient Consultation

Hygiene Appointment

Surgery

Post-Operative Appointment

Periodic Examinaton

Emergency Visit

4. How would you rate the friendliness / courtesy of our:

	Excellent	Very Good	Good	Fair	Poor
Front Office Staff?	*How would you rate the friendliness / courtesy of our: Front Office Staff? Excellent	Front Office Staff? Very Good	Front Office Staff? Good	Front Office Staff? Fair	Front Office Staff? Poor
Hygiene Staff?	Hygiene Staff? Excellent	Hygiene Staff? Very Good	Hygiene Staff? Good	Hygiene Staff? Fair	Hygiene Staff? Poor
Dental Asistants?	Dental Asistants? Excellent	Dental Asistants? Very Good	Dental Asistants? Good	Dental Asistants? Fair	Dental Asistants? Poor
Doctors?	Doctors? Excellent	Doctors? Very Good	Doctors? Good	Doctors? Fair	Doctors? Poor

Comments:

5. Was your treatment plan clearly explained?

Was your treatment plan clearly explained? Yes

Comments:

6. Was the costs and insurance benefits clearly explained to you?

Was the costs and insurance benefits clearly explained to you? Yes

Comments:

7. Overall how would you rate your experience at Campus Commons Periodontics?

Overall how would you rate your experience at Campus Commons Periodontics? Excellent

Very Good

Good

Fair

Poor

Coments

8. What is the likelihood of you recommending us to your family, friends or co-workers?

What is the likelihood of you recommending us to your family, friends or co-workers? Excellent

Very Good

Good

Fair

Poor

Other (please specify)

9. What suggestions can you make to better help us serve you and our future patients?

What suggestions can you make to better help us serve you and our future patients?

10. If you would like to be contacted regarding this survey please leave your name and best time to be reached.

If you would like to be contacted regarding this survey please leave your name and best time to be reached.

Patient Satisfaction SurveyExit this survey

1. Campus Commons Periodontics - Patient Satisfaction Survey

1. Did we call in advance to confirm your appointment?

2. How long did you wait in the reception area prior to being brought into the clinical area?

3. Why were you coming to Campus Commons Periodontics?

4. How would you rate the friendliness / courtesy of our:

5. Was your treatment plan clearly explained?

6. Was the costs and insurance benefits clearly explained to you?

7. Overall how would you rate your experience at Campus Commons Periodontics?

8. What is the likelihood of you recommending us to your family, friends or co-workers?

9. What suggestions can you make to better help us serve you and our future patients?

10. If you would like to be contacted regarding this survey please leave your name and best time to be reached.

Patient Satisfaction Survey
Exit this survey