Shelbourne Dental Clinic Satisfaction Survey

We would like to know how you feel about the services we provide, so we can make sure that we are meeting your expectations. Your responses help us to improve our service. All responses are anonymous and confidential. Thank you for your time.

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1. Are you

Male

Female

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2. How often do you go to the dentist for a check-up?

At least every 6 months

Once a year

Once every 2 years

Occasionally

Only when I have a problem

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3. Which dentist(s) do you usually see?

Dr. Karl Cassidy

Dr. Mark Kelly

Dr. Tom Canning

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4. Ease of getting an appointment

	Excellent	Good	Fair	Poor	N/A
Convenient appointment available	Convenient appointment available Excellent	Convenient appointment available Good	Convenient appointment available Fair	Convenient appointment available Poor	Convenient appointment available N/A
Hours clinic is open	Hours clinic is open Excellent	Hours clinic is open Good	Hours clinic is open Fair	Hours clinic is open Poor	Hours clinic is open N/A
Convenience of clinic location	Convenience of clinic location Excellent	Convenience of clinic location Good	Convenience of clinic location Fair	Convenience of clinic location Poor	Convenience of clinic location N/A

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5. Waiting

	Excellent	Good	Fair	Poor	N/A
Time kept waiting	Time kept waiting Excellent	Time kept waiting Good	Time kept waiting Fair	Time kept waiting Poor	Time kept waiting N/A
Comfort while waiting	Comfort while waiting Excellent	Comfort while waiting Good	Comfort while waiting Fair	Comfort while waiting Poor	Comfort while waiting N/A

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6. Dentist

	Excellent	Good	Fair	Poor	N/A
Listens to you	Listens to you Excellent	Listens to you Good	Listens to you Fair	Listens to you Poor	Listens to you N/A
Takes enough time with you	Takes enough time with you Excellent	Takes enough time with you Good	Takes enough time with you Fair	Takes enough time with you Poor	Takes enough time with you N/A
Explains what you want to know	Explains what you want to know Excellent	Explains what you want to know Good	Explains what you want to know Fair	Explains what you want to know Poor	Explains what you want to know N/A
Gives you good advice and treatment	Gives you good advice and treatment Excellent	Gives you good advice and treatment Good	Gives you good advice and treatment Fair	Gives you good advice and treatment Poor	Gives you good advice and treatment N/A

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7. Dental Nurses

	Excellent	Good	Fair	Poor	N/A
Helpful and friendly to you	Helpful and friendly to you Excellent	Helpful and friendly to you Good	Helpful and friendly to you Fair	Helpful and friendly to you Poor	Helpful and friendly to you N/A
Listen to you	Listen to you Excellent	Listen to you Good	Listen to you Fair	Listen to you Poor	Listen to you N/A
Take enough time with you	Take enough time with you Excellent	Take enough time with you Good	Take enough time with you Fair	Take enough time with you Poor	Take enough time with you N/A
Explain what you want to know	Explain what you want to know Excellent	Explain what you want to know Good	Explain what you want to know Fair	Explain what you want to know Poor	Explain what you want to know N/A

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8. Reception

	Excellent	Good	Fair	Poor	N/A
Helpful and friendly to you	Helpful and friendly to you Excellent	Helpful and friendly to you Good	Helpful and friendly to you Fair	Helpful and friendly to you Poor	Helpful and friendly to you N/A
Answers your questions	Answers your questions Excellent	Answers your questions Good	Answers your questions Fair	Answers your questions Poor	Answers your questions N/A
Courtesy on telephone/email	Courtesy on telephone/email Excellent	Courtesy on telephone/email Good	Courtesy on telephone/email Fair	Courtesy on telephone/email Poor	Courtesy on telephone/email N/A
Queries answered quickly	Queries answered quickly Excellent	Queries answered quickly Good	Queries answered quickly Fair	Queries answered quickly Poor	Queries answered quickly N/A

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9. Charges/Billing

	Excellent	Good	Fair	Poor	N/A
Value of services	Value of services Excellent	Value of services Good	Value of services Fair	Value of services Poor	Value of services N/A
Explanation of charges	Explanation of charges Excellent	Explanation of charges Good	Explanation of charges Fair	Explanation of charges Poor	Explanation of charges N/A
Payment options	Payment options Excellent	Payment options Good	Payment options Fair	Payment options Poor	Payment options N/A

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10. Facility

	Excellent	Good	Fair	Poor	N/A
Neat and clean surroundings	Neat and clean surroundings Excellent	Neat and clean surroundings Good	Neat and clean surroundings Fair	Neat and clean surroundings Poor	Neat and clean surroundings N/A
Comfort of dental chair	Comfort of dental chair Excellent	Comfort of dental chair Good	Comfort of dental chair Fair	Comfort of dental chair Poor	Comfort of dental chair N/A
Use of technology	Use of technology Excellent	Use of technology Good	Use of technology Fair	Use of technology Poor	Use of technology N/A
Privacy	Privacy Excellent	Privacy Good	Privacy Fair	Privacy Poor	Privacy N/A

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11. Would you refer us to your friends or relatives?

Yes

Maybe

No

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12. What do you like best about our clinic?

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13. What do you like least about our clinic?

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14. How could we improve our service?