Balcombe Road Dental -Patient Survey Patient Feedback -Thank you for taking the time to do this survey Question Title * 1. How likely is it that you would recommend Balcombe Road Dental to a friend or colleague? NOT AT ALL LIKELY EXTREMELY LIKELY 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 OK Question Title * 2. How did you hear about Balcombe Road Dental? Friends and Family Advertising Patient of previous Dentist that used to work here Google Facebook Word of Mouth Newspaper Other (please specify) OK Question Title * 3. Overall, how satisfied or dissatisfied are you with clinic? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Other (please specify) OK Question Title * 4. Which of the following apply to your experience here? Easy to Make appointment Aware of 24/7 Online Booking Received a reminder for each appointment Easy to rebook appointments Seen on time for my appointment Clean and Presentable Friendly Staff Fees were Fair Dentist was professional and courteous comfortable waiting area Recall Rewards for patient's regular checkups Other (please specify) OK Question Title * 5. What dental procedure are you interested in? Teeth whitening General Dental care Denture Care Orthodontic (braces, invisible aligners) children's Dental care Other (please specify) OK Question Title * 6. How would you rate the fees for your dental visit? Excellent Above average Average Below average Poor OK Question Title * 7. How long have you been a patient of ours? This is my first time Less than six months Six months to a year 1 - 2 years OK Question Title * 8. Is there anything we could have done to improve your last visit? OK Question Title * 9. Do you have any other comments, questions, and concerns? OK Question Title * 10. What is your preferred way of contact? By email By phone SMS No preference Name (optional) OK DONE