Satisfaction Survey

    Step 1 of 2: Fill Out the Satisfaction Survey

    Name :
    Email :

    (5-1 Scoring, 5=Highly Satisfied, 1=Not Satisfied) Highly Satisfied, Not Satisfied

    Questions

    1. Was it easy to schedule a convenient appointment? : 12345

    2. Were you greeted in a prompt and friendly manner? : 12345

    3. Was the dental hygienist professional and courteous? : 12345

    4. Were the fees for your treatment explained to your satisfaction? : 12345

    5. Was the dentist considerate and sensitive to your needs? : 12345

    6. How would you rate the cleanliness of the dental facility? : 12345

    7. Was your dental treatment completed to your satisfaction? : 12345

    8. How would you rate your overall experience? : 12345

    Yes/No Answers

    9. Would you return to our dental practice for future work? : YesNo

    10. Would you refer a friend to our dental practice in the future? : YesNo

    Comments, Questions, Suggestions: