Cosmetic Restorative Dentistry
Leading Cosmetic Dentistry based in Florida offering Cosmetic Dental Services, Dental Implants, Dental Bridges, Dental Care, porcelain veneers, restorative dentistry, teeth whitening and oral heath care services across USA
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Cosmetic Dentists USA
 
Leading Cosmetic Dentistry based in Florida offering Cosmetic Dental Services, Dental Implants, Dental Bridges, Dental Care, porcelain veneers, restorative dentistry, teeth whitening and oral heath care services across USA
Cosmetic Dentists USA
 
Leading Cosmetic Dentistry based in Florida offering Cosmetic Dental Services, Dental Implants, Dental Bridges, Dental Care, porcelain veneers, restorative dentistry, teeth whitening and oral heath care services across USA
 

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Patient Satisfaction Survey

Please answer the following questions. We will use the results to be more responsive to your needs. Your answers will be confidential. Please feel free to tell us what you think.

Full Name *
Email Address *
On a one-to-five scale, with 1: terrible, 2: poor, 3: okay, 4: very good and
5: excellent, please rate each of the following statements.
1 2 3 4 5
1. How would you rate the care you receive from your dentist and his/her staff?
2. More specifically, how would you rate each of the following:          
  a. Dentist
  b. Dental Hygienist
  c. Receptionist
  d. Dental Assistant/Chair side staff
  e. Administrative Staff
3. The cleanliness of the office
4. Office operations
5. The atmosphere of the office
6. The office d?cor
7. From your experience, how would you rate the technical skills of your dentist?
 
On a one-to-five scale, with 1: strongly disagree, 2: disagree, 3: neutral or undecided,
4: agree and 5: strongly agree, please rate each of the following statements.
1 2 3 4 5
8. The dentist and the staff attending me always put on fresh, sterile gloves before treating me.
9. I appreciate the dental staff reminding me of check-up times.
10. My dentist cares about me as a person.
11. My dentist and the staff make me want to have the best oral health possible.
12. I am confident that my dentist practices all of the proper sterilization procedures
13. My dentist is never too busy to answer any questions I have.
14. My dentist keeps current with the latest dental procedures.
15. The doctor and staff are considerate of my feelings.
16. I always feel better about myself after I have visited this dentist
17. I know what my doctor expects me to do to improve my oral health
18. My dentist gives me a thorough examination before he/she does any treatment.
19. For my last visit to the dental office, the doctor or staff member was ready for me at the appointed time.
20. My dentist has helped me understand that I can keep my natural teeth for a lifetime.
21. It has been easy for me to get appointments to see my dentist.
22. I believe this dental practice is the best available for the treatment I need.
23. My dentist asks for my opinions about the treatment program.
24. My dentist is my friend.
25. My dentist seems to be excited when he/she sees any improvement in my oral health.
26. My dentist knows a lot about me as an individual.
27. My dentist has helped me learn that I am in control of my health.
28. I do not expect to have any teeth (excluding wisdom teeth) extracted during the rest of my life.
29. There is at least one person on the staff of this office whom I feel is a close friend.
30. Has your dentist referred you to a specialist?          
  a. If so, did the specialist have complimentary things to say about your dentist? Yes   No
  b. Did the specialist provide you high quality care? Yes   No
     
31. What do you like best about this dental office?
     
32. Please write any comments here that you feel will be helpful in providing better service to you and others.
33. Enter Code as shown in the box:
 
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