Patient Satisfaction Survey (Page 2 of 2) in pdf

Patient Satisfaction Survey Page 2

Patient Satisfaction Survey (continued)

Staff

Agree

Unsure Disagree

"# The dentist was professional and courteous.

"# The dental hygienist was professional and courteous.

"# The dental assistant was professional and courteous.

The dentist was considerate and sensitive to my needs.

The dental hygientist was considerate and sensitive to my needs.

"# The dental assistant was considerate and sensitive to my needs.

"# Other office personnel were courteous and helpful.

Comments:_________________________________________________________________________

Treatment

Agree

Unsure Disagree

"# My proposed dental treatment was clearly explained.

"# Any questions I had were answered.

"# I was given treatment alternatives

"# My dental treatment was completed efficiently and in a timely manner.

"# I was pleased with the quality of my dental treatment.

"# The dental treatment was completed to my satisfaction.

"# The fees were explained prior to my treatment appointment.

"# The fees for service were fair.

"# I plan to remain a patient at this office.

Comments: ________________________________________________________________________

Additional Comments

What I liked best about the office was: ___________________________________________________

What I liked least about the office was: ___________________________________________________

In what way(s) could we have made your experience better?

__________________________________________________________________________________

Name (optional) _____________________________________________________________________

Patient Satisfaction Survey Page 2