Patient Satisfaction Survey

1. Midwest Dental Patient Satisfaction Survey

Welcome to the Midwest Dental Patient Satisfaction Survey! We appreciate your feedback and look forward to reviewing any comments and concerns you may have. The survey will take about 5 minutes. Thank you!

1. Please rate your satisfaction level regarding the following items: (1 = not satisfied, 5 = highly satisfied)

	1 - Not Satisfied	2	3	4	5 - Highly Satisfied	N/A
Was it easy to schedule a convenient appointment?	*Please rate your satisfaction level regarding the following items: (1 = not satisfied, 5 = highly satisfied) Was it easy to schedule a convenient appointment? 1 - Not Satisfied	Was it easy to schedule a convenient appointment? 2	Was it easy to schedule a convenient appointment? 3	Was it easy to schedule a convenient appointment? 4	Was it easy to schedule a convenient appointment? 5 - Highly Satisfied	Was it easy to schedule a convenient appointment? N/A
Were you greeted in a prompt and friendly manner?	Were you greeted in a prompt and friendly manner? 1 - Not Satisfied	Were you greeted in a prompt and friendly manner? 2	Were you greeted in a prompt and friendly manner? 3	Were you greeted in a prompt and friendly manner? 4	Were you greeted in a prompt and friendly manner? 5 - Highly Satisfied	Were you greeted in a prompt and friendly manner? N/A
Was the dentist and/or hygienist sensitive to your needs?	Was the dentist and/or hygienist sensitive to your needs? 1 - Not Satisfied	Was the dentist and/or hygienist sensitive to your needs? 2	Was the dentist and/or hygienist sensitive to your needs? 3	Was the dentist and/or hygienist sensitive to your needs? 4	Was the dentist and/or hygienist sensitive to your needs? 5 - Highly Satisfied	Was the dentist and/or hygienist sensitive to your needs? N/A
Was your waiting time in the reception area reasonable?	Was your waiting time in the reception area reasonable? 1 - Not Satisfied	Was your waiting time in the reception area reasonable? 2	Was your waiting time in the reception area reasonable? 3	Was your waiting time in the reception area reasonable? 4	Was your waiting time in the reception area reasonable? 5 - Highly Satisfied	Was your waiting time in the reception area reasonable? N/A
Was your treatment explained to your satisfaction?	Was your treatment explained to your satisfaction? 1 - Not Satisfied	Was your treatment explained to your satisfaction? 2	Was your treatment explained to your satisfaction? 3	Was your treatment explained to your satisfaction? 4	Was your treatment explained to your satisfaction? 5 - Highly Satisfied	Was your treatment explained to your satisfaction? N/A
How would you rate the cleanliness of the dental clinic?	How would you rate the cleanliness of the dental clinic? 1 - Not Satisfied	How would you rate the cleanliness of the dental clinic? 2	How would you rate the cleanliness of the dental clinic? 3	How would you rate the cleanliness of the dental clinic? 4	How would you rate the cleanliness of the dental clinic? 5 - Highly Satisfied	How would you rate the cleanliness of the dental clinic? N/A
Was your dental treatment completed to your satisfaction?	Was your dental treatment completed to your satisfaction? 1 - Not Satisfied	Was your dental treatment completed to your satisfaction? 2	Was your dental treatment completed to your satisfaction? 3	Was your dental treatment completed to your satisfaction? 4	Was your dental treatment completed to your satisfaction? 5 - Highly Satisfied	Was your dental treatment completed to your satisfaction? N/A
How would you rate your overall experience at Midwest Dental?	How would you rate your overall experience at Midwest Dental? 1 - Not Satisfied	How would you rate your overall experience at Midwest Dental? 2	How would you rate your overall experience at Midwest Dental? 3	How would you rate your overall experience at Midwest Dental? 4	How would you rate your overall experience at Midwest Dental? 5 - Highly Satisfied	How would you rate your overall experience at Midwest Dental? N/A

2. Will you return to Midwest Dental for future treatment?

Will you return to Midwest Dental for future treatment? Yes

3. Would you refer a friend to Midwest Dental?

Would you refer a friend to Midwest Dental? Yes

4. Is this your first visit to this clinic?

Is this your first visit to this clinic? Yes

5. Comments: We welcome any comments or concerns in order to help us improve our business. This information will not be made public.

Comments: We welcome any comments or concerns in order to help us improve our business. This information will not be made public.