Patient Feedback form - The Pepper Clinics

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Patient Feedback form - The Pepper Clinics - The Hamptons Dental Care

The purpose of this survey is so that we, at your Dental Practice, can find out what you think of the service you have received from us. This information can help to further improve how we look after you. We really appreciate the time you will take to provide us with this feedback - Thank you

1. Which of the following best describes the reason why you saw the Dentist today?

To ask for advice

Routine appointment

Ongoing problem

In pain

Clear selection

2. How were you greeted by our reception team?

Less than satisfactory

Satisfactory

Good

Very Good

Other:

Clear selection

3. Was the Dentist polite?

Yes

Other:

Clear selection

4. Do you feel that the Dentist answered fully any queries you may have had?

Yes

Other:

Clear selection

5. Were you involved in making the decision on treatment with the Dentist?

Yes

N/A

Other:

Clear selection

6. Were any costs of treatment explained to you fully?

Yes

Other:

Clear selection

7. Do you feel the Dentist really listened to your concerns,and tried their best for you?

Yes

Other:

Clear selection

8.How could we improve our service for you?

9. Would you recommend friends and family to us?

Yes

N/A

Other:

Clear selection

10. How do you feel about the following statement:

'I trust the Dentist to maintain confidentiality of information'

Please add any other comments about your treatment with us

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.