Kingston Beach Dental Patient Evaluation Question Title * 1. How did you hear about us? Internet/online Yellow Pages Family Friend Professional Referral Newspaper Other (please specify) Question Title * 2. Are our opening hours convenient for you? Very convenient Convenient Somewhat convenient Inconvenient Not important Question Title * 3. How would you rate the cleanliness and atmosphere of the clinic? Excellent Good Satisfactory Poor Needs improvement Why? Question Title * 4. Was the Receptionist helpful, polite and pleasant? Excellent Good Satisfactory Poor Needs improvement Why? Question Title * 5. Was the Dental Assistant friendly, supportive and attentive? Excellent Good Satisfactory Poor Needs improvement Why? Question Title * 6. How do you rate the clinical skills of the Dentist (competent, confident, focused and gentle)? Excellent Good Satisfactory Poor Needs improvement Why? Question Title * 7. How well did the Dentist explain your treatment, answer your questions, and listen to your concerns in a polite and friendly manner? Excellent Good Satisfactory Poor Needs improvement Other (please specify) Question Title * 8. How would you rate the overall quality of the service and dental care and treatment provided for you at Kingston Beach Dental? Please tick and comment below Excellent Good Satisfactory Poor Needs improvement, I will not come back to Kingston Beach Dental Other (please specify) Question Title * 9. How likely are you to recommend Kingston Beach Dental to family or friends? Will definitely recommend Would possibly recommend Would not recommend Why? Question Title * 10. Do you have any other comments, questions, or concerns? Please leave your contact details if you require follow up Done