Facility

How do you think about our facility?
    Excellent Good Fair Poor
1.
Waiting Time

In your most recent visit; how long did you have to wait in the practice before you could be seen by the dentist
Excellent = less than 15 minutes
Poor = More than 45 minutes

2.
How is our health and safety protocol during pandemic Covid-19
3.
How is our reception area

(The cleanliness, the music and the temperature)

4.
The Cost

It is our policy to provide all patients with a detailed treatment plan and a clear breakdown of costs before any treatment starts. How satisfied are you with the information given to you about the cost of your treatment?

5.
Stars

How many stars would you give to our practice?
5 stars = excellent
4 stars = good
3 stars = fair
2 stars = poor

1. Waiting Time

In your most recent visit; how long did you have to wait in the practice before you could be seen by the dentist
Excellent = less than 15 minutes
Poor = More than 45 minutes

2. How is our health and safety protocol during pandemic Covid-19
3. How is our reception area

(The cleanliness, the music and the temperature)

4. The Cost

It is our policy to provide all patients with a detailed treatment plan and a clear breakdown of costs before any treatment starts. How satisfied are you with the information given to you about the cost of your treatment?

5. Stars

How many stars would you give to our practice?
5 stars = excellent
4 stars = good
3 stars = fair
2 stars = poor

Team

How do you think about our team?
    Very
Satisfied
Satisfied Dissatisfied Very
Dissatisfied
1.
Courtesy

During your visit, were you treated professionally and with respect by our front officer?

2.
Doctor

We always aim to fully involve patients in the process of decision making about their treatments. How satisfied are you with the doctor explanation about your treatment? And how are you satisfied with the outcome of your treatment?

3.
Dental Assistant

How satisfied are you with the dental assistant role during your treatment in the operation room?

4.
Loyalty & Recommend

How likely are you to come and recommend our practice to your family and friends?

1. Courtesy

During your visit, were you treated professionally and with respect by our front officer?

2. Doctor

We always aim to fully involve patients in the process of decision making about their treatments. How satisfied are you with the doctor explanation about your treatment? And how are you satisfied with the outcome of your treatment?

3. Dental Assistant

How satisfied are you with the dental assistant role during your treatment in the operation room?

4. Loyalty & Recommend

How likely are you to come and recommend our practice to your family and friends?

Additional

DENTIST
Who is your dentist?
GOT IT RIGHT

Please write a few things that you liked about our practice: (optional)

IMPROVEMENT

Please write a few things that you think we should improve in our practice: (optional)

Finish

You can write any other comments you may have below: (optional)

Patient Name: (optional)
Email: (optional)