Patient Care Survey
We are always looking for ways in which we can improve the services we provide. The input we receive from patients is extremely valuable in helping us achieve this goal.
Thank you for taking the time to complete this survey.
In your initial contact with our office, did the receptionist treat you in a courteous, professional and informative manner?
Disappointing
Outstanding
1
2
3
4
5
When you arrived at the office, did our staff treat you in a friendly and professional manner?
Disappointing
Outstanding
1
2
3
4
5
How long did you have to wait prior to seeing the doctor?
Greater than 30 minutes
10-30 minutes
Less than 30 minutes
Did you feel as though the hygienist was knowledgeable, competent and thorough?
Disappointing
Outstanding
1
2
3
4
5
Did the hygienist provide adequate homecare instruction and promote appropriate oral hygiene aides?
(For example: electric brushes, floss aides and proxybrushes)
Disappointing
Outstanding
1
2
3
4
5
How was your overall dental cleaning experience with the hygienist?
Disappointing
Outstanding
1
2
3
4
5
Was the treatment plan presented by the doctor clear and logical?
Disappointing
Outstanding
1
2
3
4
5
Was the staff helpful in making you feel comfortable during dental treatment?
Disappointing
Outstanding
1
2
3
4
5
Did the results of your treatment meet your expectations?
Disappointing
Outstanding
1
2
3
4
5
Why did you choose our office?
A. Referral from Dentist
B. Referral from a patient of the practice
C. Referral from a friend or family member
D. Know the doctor
E. Reputation of the office
F. Internet/Website
G. Church Bulletin
H. Other (please explain below)
How might we make your visit to our office more comfortable?
Were you disappointed with anything concerning our office?
Was a member of our staff particularly helpful during your visit to our office?
Please remember to tell your friends about us.
We are committed to striving for excellence and look forward to continuing that commitment.
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email (optional)
