PDO Please Help Us

How satisfied are you with the following:

	Very Satisfied	Satisfied	Neutral	Unsatisfied	Very Unsatisfied
Phone Support

Website

Customer Service

Overall Visit

How long has your child been a patient at PDO?

6 months or less

12 months to 3 years

3 years to 5 years

Greater than 5 years

Was the staff courteous and did they make you and your child feel welcome from the moment you entered the practice?

Strongly Agree

Agree

Disagree

Strongly Disagree

How did we do on our phone support? What can we do better?

Was the hygienist/assistant patient, understanding, and knowledgeable in her duties?

Strongly Agree

Agree

Disagree

Strongly Disagree

Did the Doctor explain clearly the results of your child/childrens visit?

Strongly Agree

Agree

Disagree

Strongly Disagree

Was the doctor caring, gentle and perform their duties to your satisfaction?

Strongly Agree

Agree

Disagree

Strongly Disagree

Was the office clean, comfortable, and kid friendly?

Strongly Agree

Agree

Disagree

Strongly Disagree

Did we offer you a re-appointment at the end of the visit?

yes

no

Did we provide adequate Insurance coverage information? Were we helpful explaining YOUR benefits to you?

Strongly Agree

Agree

Disagree

Strongly Disagree

Was your appointment on time and did we meet your expectations regarding the length of the appointment?

Strongly Agree

Agree

Disagree

Strongly Disagree

Did we handle the billing and payment issues correctly?

Strongly Agree

Agree

Disagree

Strongly Disagree

Was the billing staff courteous and helpful regarding your account?

Strongly Agree

Agree

Disagree

Strongly Disagree

Will you continue to be a customer of PDO?

Strongly Agree

Agree

Disagree

Strongly disagree

Would you refer patients to our practice?

Strongly Agree

Agree

Disagree

Strongly Disagree

Did we provide a good value for your healthcare dollars?

Strongly Agree

Agree

Disagree

Strongly Disagree

Please use this space to tell us about anything you think we should know about. You're answers will be kept confidential.