Patient Satisfaction Survey
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.  Your responses are directly responsible for improving these services.  All responses will be kept confidential and anonymous.  Thank you for your time.

If any questions please contact Quality Improvement Coordinator: Dominic Trujillo at 505-869-4468 or dominic.trujillo@islclinic.net
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Please answer questions below *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
An Appointment was available when I needed it
When I arrived for my visit, I did not have to wait more than 20 minutes past my scheduled appointment to be seen
The dental staff was courteous
The reception & treatment areas were clean
The dentist was welcoming & gentle
The dentist & team listened & understood my dental concerns
The dentist explains procedures/treatment plan(s) clearly & concisely
I was given the chance to provide input into decisions about my care
I observed the dentist/assistant washing/sanitizing their hands before and after examining me
My culture and traditions were respected
Overall, I am quite satisfied with the care I receive
What brought you in for your latest visit? *
How long have you been a patient with the Dental Clinic? *
Date of Service *
MM
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