Your Name (Optional, but it helps us direct your praise or criticism to relevant members of the team)
First Name
Last Name
How did you make your initial appointment?
I walked in
I called up
Through the website
I sent an email
How easy was it for you to make an appointment?
1
2
3
4
5
Very difficult
Very Easy
1 is Very difficult, 5 is Very Easy
How quickly did our office team help you with your enquiries?
1
2
3
4
5
Very slowly
Very quicly
1 is Very slowly, 5 is Very quicly
How knowledgable were our office staff?
1
2
3
4
5
Clueless
Very knowledgable
1 is Clueless, 5 is Very knowledgable
How friendly were our office staff?
1
2
3
4
5
Unfriendly
Very friendly
1 is Unfriendly, 5 is Very friendly
Did you see a dentist at DS Dental Studio?
Yes
No
Dentists
Did your dentist spend too much time with you, too little, or about the right amount of time with you?
1
2
3
4
5
Too much
Too little
1 is Too much, 5 is Too little
How much did you trust your dentist to suggest treatments that are in your best interests?
1
2
3
4
5
Trust little
Trust completely
1 is Trust little, 5 is Trust completely
How helpful was your dentist at explaining your dental needs?
1
2
3
4
5
Not at all helpful
Extremely helpful
1 is Not at all helpful, 5 is Extremely helpful
Overall, are you satisfied with your dentist?
1
2
3
4
5
Extremely unsatisfied
Completely
1 is Extremely unsatisfied, 5 is Completely
How likely are you to recommend your dentist to family or friends?
1
2
3
4
5
Not likely
Very likely
1 is Not likely, 5 is Very likely
Did you see a hygienist during your course of treatment?
Yes
No
Hygienists
How helpful was your hygienist at explaining your oral hygiene needs?
1
2
3
4
5
Not at all helpful
Extremely helpful
1 is Not at all helpful, 5 is Extremely helpful
How happy were you with your dental hygiene treatment?
1
2
3
4
5
Very unhappy
Very pleased
1 is Very unhappy, 5 is Very pleased
Did your hygienist recommend enough products for you to improve your oral hygiene?
1
2
3
4
5
Not enough
Too much
1 is Not enough, 5 is Too much
No hygiene
The reason you didn't see a hygienist?
I couldn't afford it
I have an appointment coming up / will book one
I was not due to see one
I was not recommended to see one
Other
Please specify
Any other comments?
Your comments and views are much appreciated
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