PATIENT SATISFACTION SURVEY
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) *
Your answer
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) *
Your answer
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 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
Your answer
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