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.

	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

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

	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

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

	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

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

	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

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

	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

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

	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

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

	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

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

Shelbourne Dental Clinic Satisfaction Survey

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1. Are you

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

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

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4. Ease of getting an appointment

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5. Waiting

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6. Dentist

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7. Dental Nurses

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8. Reception

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9. Charges/Billing

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10. Facility

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

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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?