Patient Satisfaction Survey Name PhoneEmail When you enter our office for a dental appointment, do you receive a friendly greeting from the receptionist and/or other members of the office staff? Always Usually Occasionally Rarely Never When you call to make or change an appointment, is the office staff polite, courteous, and helpful in finding you an available appointment date and time? Always Usually Occasionally Rarely Never Does the dentist and assistants take an adequate amount of time to explain your proposed treatment, ensure that you understand, and take time to answer your questions? Always Usually Occasionally Rarely Never When you visit our office, how long do you usually wait in the reception area (after the scheduled time of your appointment) before you are seated in the dental chair? Little or no time 1-10 minutes 10-20 minutes 20+ minutes After being seated in the dental chair, how long do you usually wait before seeing the dentist, dental hygienist, or other staff for treatment? Little or no time 1-10 minutes 10-20 minutes 20+ minutes How would you rate the professionalism of the denstist(s) in our practice? Very professional Average Too casual Not professional How would you rate the professionalism of the dental hygienist(s) and dental assistant(s) in our practice? Very professional Average Too casual Not professional How would you rate the professionalism of the receptionist(s) and other members of the office staff? Very professional Average Too casual Not professional Are you satisfied with the way you are treated in our dental office? Yes No If no, please explain:What can we do to improve your next visit?
