Patient Satisfaction Survey

Tell us about your experience

A patient’s evaluation of the care received at our practice is an extremely important form of feedback that provides valuable information about the services we provide. We encourage patients to provide both positive and negative feedback.

How did you find out about our practice?
Was the person who scheduled your appointment courteous and helpful?
How would you rate the courtesy of the staff at the reception desk?
How long did you wait in the reception area beyond your scheduled appointment time?
Mark the boxes that characterised the demeanour of your clinician.
Please rate the clarity of the clinician’s explanation of your condition and treatment options.
Were your questions answered to your satisfaction?
Mark the boxes that characterised the demeanour of your dental assistant.
Mark the boxes that describe the suctioning technique of the dental assistant during treatment.
How would you rate the practice (appearance, comfort and atmosphere).
Would you recommend this facility and its staff to your family and friends?
How would you rate our concern for your privacy?
What did you like best about the practice?
What did you like least about the practice?
In what way(s) could we have made your experience better?
Additional comments (Please share any additional comments or suggestions)
Would you like someone to contact you regarding your responses on this survey?
Providing the following information is optional.
Name
Address
Telephone
Gender
Age