Patient Feedback Survey
Thank you for being a patient at The DENTAL Place!
We want to hear your feedback so we can keep improving our service. Please fill this quick survey and let us know your thoughts.
*This survey is required to enter in our 12th year anniversary giveaway*
* Required
Email address
*
Your email
Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
How many visits have you made to our office in the past year?
*
1
2
3
4
5 or more
It was easy to make my first appointment
*
Disagree
1
2
3
4
5
Agree
The front office was polite and helpful
*
Disagree
1
2
3
4
5
Agree
I received a reminder of each of my appointments
*
Disagree
1
2
3
4
5
Agree
It was easy to schedule a convenient appointment
*
Disagree
1
2
3
4
5
Agree
Appointment options were given that suited my schedule
*
Disagree
1
2
3
4
5
Agree
I was seen on time for my appointments
*
Disagree
1
2
3
4
5
Agree
The area was neat and clean
*
Disagree
1
2
3
4
5
Agree
The equipment was clean and presentable
*
Disagree
1
2
3
4
5
Agree
The temperature in the office was comfortable
*
Disagree
1
2
3
4
5
Agree
The lighting in the office was sufficient
*
Disagree
1
2
3
4
5
Agree
The music in the office was pleasant
*
Disagree
1
2
3
4
5
Agree
The dentist and dental assistant was professional and courteous
*
Disagree
1
2
3
4
5
Agree
The dentist and dental assistant was considerate and sensitive to my needs
*
Disagree
1
2
3
4
5
Agree
Other office personnel were courteous and helpful
*
Disagree
1
2
3
4
5
Agree
My proposed dental treatment was clearly explained
*
Disagree
1
2
3
4
5
Agree
Any questions I had were answered
*
Disagree
1
2
3
4
5
Agree
I was given treatment alternatives
*
Disagree
1
2
3
4
5
Agree
My dental treatment was completed efficiently and in a timely manner
*
Disagree
1
2
3
4
5
Agree
I was pleased with the quality of my dental treatment
*
Disagree
1
2
3
4
5
Agree
The dental treatment was completed to my satisfaction
*
Disagree
1
2
3
4
5
Agree
The fees were explained prior to my treatment appointment
*
Disagree
1
2
3
4
5
Agree
The fees for service were fair
*
Disagree
1
2
3
4
5
Agree
I plan to remain a patient at this office
*
Disagree
1
2
3
4
5
Agree
What I liked BEST about the office was:
Your answer
What I liked LEAST about the office was:
Your answer
In what way(s) could we have made your experience better?
Your answer
Any additional comments?
Your answer
Send me a copy of my responses.
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