Survey

Please tell us 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.

Full Name (required)

Your Email (required)

What was the purpose of this visit?

 Cleaning Root Canal Crown Filling Bridge Implant Other

Ease of getting care

Ability to get in to be seen

 Excellent Good Fair Poor N/A

Hours Center is open

 Excellent Good Fair Poor N/A

Convenience of Center’s location

 Excellent Good Fair Poor N/A

Prompt return on calls

 Excellent Good Fair Poor N/A

Waiting

Time in waiting room

 Excellent Good Fair Poor N/A

Time in exam room

 Excellent Good Fair Poor N/A

Waiting for tests to be performed

 Excellent Good Fair Poor N/A

Waiting for test results

 Excellent Good Fair Poor N/A

Dentist

Listens to you

 Excellent Good Fair Poor N/A

Takes enough time with you

 Excellent Good Fair Poor N/A

Explains what you want to know

 Excellent Good Fair Poor N/A

Gives you good advice and treatment

 Excellent Good Fair Poor N/A

Dental Hygienist

Friendly and helpful to you

 Excellent Good Fair Poor N/A

Listens to you

 Excellent Good Fair Poor N/A

Takes enough time with you

 Excellent Good Fair Poor N/A

Explains what you want to know

 Excellent Good Fair Poor N/A

Gives you good advice and treatment

 Excellent Good Fair Poor N/A

Dental Assistant

Friendly and helpful to you

 Excellent Good Fair Poor N/A

Listens to you

 Excellent Good Fair Poor N/A

Facility

Neat and clean building

 Excellent Good Fair Poor N/A

Comfort and Safety while waiting

 Excellent Good Fair Poor N/A

Comfort of Dental chair
 Excellent Good Fair Poor N/A

Warm and inviting

 Excellent Good Fair Poor N/A

Privacy
 Excellent Good Fair Poor N/A

Would you refer us to your friends or relatives?

 Yes No Maybe

What do you like best about our center?

Suggestions for Improvement?

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