* 1. What is your age?

* 2. Number of visits I have made to the office in the past year

* 3. Appointments

  strongly agree  agree  neutral  disagree  strongly disagree N/A
The appointment secretary (coordinator) was polite and helpful. 
I received a reminder of each of my appointments. 
Appointment options were given that suited my schedule.
I was seen on time for my appointments; if not, I was given a reason for the delay. 

* 4. Facilities

  strongly agree agree neutral  disagree  strongly disagree N/A
The office location and parking are convenient. 
The reception area was neat and clean.
The temperature in the office was comfortable. 
The music in the office was pleasant. 
The lighting in the office was sufficient. 
The equipment was clean and presentable. 

* 5. Staff

  strongly agree agree neutral disagree strongly disagree  N/A
The dentist was professional and courteous. 
The dental hygienist was professional and courteous. 
The dental assistant was professional and courteous. 
Other office personnel were courteous and helpful. 

* 6. Treatment

  strongly agree  agree neutral  disagree  strongly disagree N/A
My proposed dental treatment was clearly explained.
Any questions I had were answered. 
I was given treatment alternatives. 
My dental treatment was completed efficiently and in a timely manner. 
I am pleased with the quality of my dental treatment. 
The dental treatment was completed to my satisfaction. 
The fees were explained prior to my treatment appointment. 
The fees for service were fair. 
I plan to remain a patient at this office. 

* 7. What I liked best about the office was: 

* 8. What I liked least about the office was:

* 9. In what ways could we have made your experience better?

* 10. Name. (please note: your name will not appear with the answers to all previous questions as the system mixes answers and is not necessary to submit your results.)

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