To provide a higher level of service, we would like to learn more about our patients and how they feel about our practice. Please answer the following questions. All surveys will be treated as confidential. In respect of your privacy, if you prefer to remain anonymous, you do not need to fill in the “your details” section. We would love to hear from you! Please fill out this dental patient survey form and we will get in touch with you shortly. Your DetailsThis section is optional. If you wish to remain anonymous you may continue to the next section.Name Email PhoneRate your experiencePlease select a number from 1 to 5 which best represents your opinion. 1 being you "strongly disagree" and 5 being you "strongly agree"1. When I call the office, I am always treated courteously 1 2 3 4 5 2. I am able to schedule my appointments at convenient times. 1 2 3 4 5 3. When I arrive at my scheduled time, I am seen promptly. 1 2 3 4 5 4. The reception area is comfortable and inviting. 1 2 3 4 5 5. The atmosphere is friendly. 1 2 3 4 5 6. I have confidence in the cleanliness and sterilization procedures in this office. 1 2 3 4 5 7. I am made comfortable during my visits. 1 2 3 4 5 8. I am greeted by name by attending staff and doctor. 1 2 3 4 5 9. Doctor and staff work well together. 1 2 3 4 5 10. The treatment is explained to me clearly. 1 2 3 4 5 11. The doctor and staff are thorough in giving instructions and explanations. 1 2 3 4 5 12. I am informed of the fees prior to treatment. 1 2 3 4 5 13. I am given payment options for treatment. 1 2 3 4 5 14. I feel I can afford the dental care I need. 1 2 3 4 5 15. I feel my needs and concerns are heard. 1 2 3 4 5 16. I rarely experience discomfort during dental procedures. 1 2 3 4 5 17. I am kept informed of the treatment progress during my appointment. (ie what is next?) 1 2 3 4 5 18. I would refer others to this practice. 1 2 3 4 5 19. I consider an appropriate amount of time to wait before being seen to be... 20. The main reason I come to this practice:Additional Comments:CAPTCHA Don’t forget to share this via Twitter, Google+, Pinterest and LinkedIn.