reviews

Patient Satisfaction Survey

Your opinion counts. We want to know how you rate our services, facility and staff because we want to ensure that we are meeting your expectations and needs.

Your evaluation will have a direct impact on improving our practice. You can be assured that all responses will be kept confidential and anonymous. Thank you for making us a better dental practice.

First of all…

Do you consider our dental practice to be your primary source of dental care?

YesNo

Facility

Access to building (1 = Very Bad and 5 = Very Good)

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General cleanliness and condition of building (1 = Very Bad and 5= Very Good)

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Comfort and safety (1 = Very Bad and 5 = Very Good)

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The Staff...

Listen to what you are saying (1 = Very Bad and 5 = Very Good)

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Take enough time with you (1 = Very Bad and 5 = Very Good)

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Provide clear explanations and answers to your questions (1 = Very Bad and 5 = Very Good)

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Treat you with respect and friendliness (1 = Very Bad and 5 = Very Good)

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Convey a positive attitude (1 = Very Bad and 5 = Very Good)

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Payment

Financial terms and expectations are clearly communicated (1 = Very Bad and 5 = Very Good)

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Fees for services performed are explained clearly (1 = Very Bad and 5 = Very Good)

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Financial options are presented clearly (1 = Very Bad and 5 = Very Good)

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Confidentiality

You are confident that your personal information is kept private and confidential (1 = Very Bad and 5 = Very Good)

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You feel that financial discussions and/or issues are kept private and confidential (1 = Very Bad and 5 = Very Good)

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Confidence

What is the likelihood that you would refer your friends, family and acquaintances to us? (1 = Very Bad and 5 = Very Good)

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Sound Off

What do you like best about our practice?

What do you like least about our practice?

How could we improve?


Thank you so much for giving us the honest feedback that we need to keep our dental practice at the highest level of performance.

If you want to print the completed page for your records, you must do so BEFORE you send us the form.