survey

Step 1 of 2: Fill Out the Satisfaction Survey

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

Questions

1. Was it easy to schedule a convenient appointment? : 1 2 3 4 5

2. Were you greeted in a prompt and friendly manner? :  1 2 3 4 5

3. Was the dental hygienist professional and courteous? :  1 2 3 4 5

4. Were the fees for your treatment explained to your satisfaction? :  1 2 3 4 5

5. Was the dentist considerate and sensitive to your needs? :  1 2 3 4 5

6. How would you rate the cleanliness of the dental facility? :  1 2 3 4 5

7. Was your dental treatment completed to your satisfaction? :  1 2 3 4 5

8. How would you rate your overall experience? :  1 2 3 4 5

Yes/No Answers

9. Would you return to our dental practice for future work? :  Yes No

10. Would you refer a friend to our dental practice in the future? :  Yes No

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