Patient Satisfaction Survey

Patient’s Name*: *optional

QUESTIONS		 Poor Average Good Excellent
Front desk        
1.) Are you helped promptly when you arrive?
2.) Is Lindsey friendly?
3.) Is Lindsey’s dress code proper?
4.) Does Lindsey address your concerns effectively?
5.) Overall satisfaction with Lindsey
Hygiene        
6.) Is your hygiene waiting time reasonable if any?
7.) Is Sunny friendly?
8.) Does Sunny clean your teeth properly?
9.) Is Sunny gentle when cleaning your teeth?
Dental assistant        
10.) Is Christi friendly?
11.) Does Christi explain your questions properly?
12.) Is Christi gentle during dental procedures?
Phone calls        
13.) Is Lindsey cordial during phone calls?
14.) Are your concerns addressed effectively during the phone?
Dr. Ambard        
15.) Is your waiting time reasonable if any?
16.) Is Dr. Ambard gentle during dental procedures?
17.) Does Dr. Ambard explain procedures, risks, treatment, etc properly?


ADDITIONAL COMMENTS:

 

 

6900 SW - 105 th Avenue - Beaverton - OR 97008 - USA
Telephone: 503.643.6607 - Fax: 503.526.8915 - E-mail: info@ajadental.com