1. Default Section

* 1. Which dental care provider did you see during your last visit?

* 2. Please choose the response that best reflects your answer based on the rating scale below:
1 = Always
2 = Usually
3 = Sometimes
4 = Rarely
5 = Never
6 = N/A

  Always Usually Sometimes Rarely Never N/A
1. Is it easy to make an appointment?
2. Do we answer the phone promptly and politely?
3. If you were put on hold did our staff return to you in a reasonable amount of time?
4. Were you satisfied with the amount of time from your call to your appointment date?
5. Were you greeted pleasantly upon arrival for your appointment?
6. Is our reception area clean and comfortable?
7. Did we see you on time for your appointment?
8. Does our staff seem genuinely interested in you?
9. Were our examination rooms clean and comfortable?
10. Did our clinical staff treat you with compassion and respect?
11. Did our clinical staff explain the treatment to you sufficiently?
12. Did our staff provide a treatment estimate before the treatment was started?
13. If applicable did our clinical staff provide satisfactory instructions for any post treatment care? (i.e. extractions, root canals etc)
14. If your appointment was an emergency appointment was it easy to reach us or one of our clinical staff during non business hours?

* 3. Are there any areas in communication or treatment you feel we could improve upon?

* 4. Would additional office hours be more convenient to you?

* 5. Do you feel confident referring your family members, friends, or co-workers to our practice?

* 6. Was our office easy to find?

* 7. If there were one thing we could do to improve our quality of care or service, what would that be?

* 8. If there are any other comments or concerns you would like to share with us, please use the space provided

* 9. May we use your comments in print and/or on our website?

* 10. Thank you for taking the time to complete this survey. Your feedback is very important to us! We use comments to better serve our patients. If you would like us to contact you about any questions or concerns you have, please provide us with your information below.

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