* 1. The quality of my dentist's efforts to reduce my anxiety.

  Failing Disagree Neutral Good Excellent

* 2. The quality of treatment I received from the dentist.

* 3. Amount of time the dentist spent with me.

* 4. Politeness of dental staff.

* 5. Amount of time I waited in the reception area to see the dentist or hygienist.

* 6. Competence of dental staff.

* 7. Explanation of financial arrangements for treatment.

* 8. I would recommend this dental office to a relative or friend.

* 9. How were you referred to this practice?

* 10. How was your experience of the dental facility?