PATIENT SATISFACTION SURVEY

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We are constantly striving to provide better treatment and care for our patients. We would like to know how you perceive our services. Please take a few minutes to complete this Patient Survey Questionnaire. Your responses are anonymous and will be used to better the office. Your cooperation is greatly appreciated.

1. Please rate the appearance/impression of the following areas:
Please use the following scale for your responses:

5. Very Good 4. Good 3. Average 2. Poor 1. Very Poor

Waiting Room *

Reception Desk *

Treatment Rooms *

Consultation Rooms *

Please rate the appearance and professionalism of our front desk staff *

Please rate your observations as it pertains to our front desk staff (specific staff names will be helpful) *

Please rate the appearance and professionalism of our assistants *

Please rate your observations as it pertains to our assistants (specific staff names will be helpful) *

Please relate your observations as it pertains to our doctors *

Please rate the effectiveness of our appointment phone call reminder system *

Did you know that you could register online to gain access to your personal account information? *

Have you visited our website at drannewhite.com? *

Did you know that you could register online to gain access to your personal account information? *

How satisfied are you with the availability of appointment times? *

How do we rate with regards to keeping on time for your scheduled appointments? *

If you needed extra assistance with treatment (emergency appointment), how would you rate the response of the Doctor and/or Staff? *

How would you rate the way in which the treatment plan was explained to you? *

How satisfied were you with our policy on financial arrangements? *

Based on your experience, how likely are you to recommend our office to family or friends who need treatment? *

Final Comments

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