Patients Comments

 Step 1 of 2: Fill Out the Satisfaction Survey

Name: Email:
(5-1 Scoring, 5=Highly Satisfied, 1=Not Satisfied) Highly Satisfied Not Satisfied
Question 5      4      3      2      1
1. Was it easy to schedule a convenient appointment?
2. Were you greeted in a prompt and friendly manner?
3. Was the dental hygienist professional and courteous?
4. Were the fees for your treatment explained to your satisfaction?
5. Was the dentist considerate and sensitive to your needs?
6. How would you rate the cleanliness of the dental facility?
7. Was your dental treatment completed to your satisfaction?
8. How would you rate your overall experience?

Yes/No Answers
Question Yes    No
9. Would you return to our dental practice for future work?
10. Would you refer a friend to our dental practice in the future?

Comments, Questions, Suggestions:

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