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Patient Survey
1.
Please select Autumn Smile Dental office location.
1648 Tully Rd, Suite B, San Jose, CA 95122
2.
How courteous and friendly was the receptionist?
Extremely friendly
Very friendly
Somewhat friendly
Not so friendly
Not at all friendly
3.
Did the receptionist answer all your questions?
Yes
No
Other (please specify)
4.
How friendly was the dental assistant?
Extremely friendly
Very friendly
Somewhat friendly
Not so friendly
Not at all friendly
5.
How gentle was the dental assistant?
Extremely gentle
Very gentle
Somewhat gentle
Not so gentle
Not at all gentle
6.
Who was your hygienist?
Hallie Nguyen
Mai Le
Emma Nguyen
I did not see hygienist
7.
How thorough was the hygienist?
Extremely thorough
Very thorough
Somewhat thorough
Not so thorough
Not at all thorough
I did not see hygienist
8.
How gentle was the hygienist?
Extremely gentle
Very gentle
Somewhat gentle
Not so gentle
Not at all gentle
I did not see hygienist
9.
Who was your dentist?
Dr. Justin Nguyen
Dr. Clayton Tran
Dr. Toai Nguyen
Dr. Calvin Nguyen
10.
How professional was your dentist?
Extremely professional
Very professional
Somewhat professional
Not so professional
Not at all professional
11.
Overall, how would you rate your dentist's quality of work?
Far above average
Above average
Average
Below average
Far below average
12.
Overall, how would you rate your experience at Autumn Smile Dental?
Very positive
Somewhat positive
Neutral
Somewhat negative
Very negative
13.
On a scale of 0 to 10,
How likely is it that you would recommend Autumn Smile Dental to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
14.
What did you like best about this practice and its services?
15.
What did you dislike about this practice and its services?
16.
In what way could we improve your experience?
Current Progress,
0 of 16 answered
