This free survey is powered by QUESTIONPRO.COM
  1. Surveys
  2. 2003
  3. December
  4. U
  5. Untitled
0%
 

How was your visit?
 
Excellent
 
Good
 
Average
 
Poor
 
Other
 
 
 

Were you greeted upon entering our office:
 
Yes
 
No
 
Other
 
 
 

Were you seated in a timely fashion?
 
Yes
 
No
 
Other
 
 
 

Was your procedure explained to you?
 
Yes
 
No
 
Other
 
 
 

During your visit, did your Assistant/Hygienist/Dentist/Front Office, etc. answer/address any questions or concerns you had about today's visit?
 
Yes
 
No
 
Other
 
 
 

What is the overall friendliness of our staff?
 
Excellent
 
Good
 
Average
 
Poor
 
Other
 
 
 

Cleanliness of our office (waiting room, bathroom, etc.):
 
Excellent
 
Good
 
Average
 
Poor
 
Other
 
 
 

What is the overall appearance of our office staff?
 
Excellent
 
Good
 
Average
 
Poor
 
Other
 
 
 
 
Please tell us how we can make your next visit better?
   
 
 
 
Did this survey miss a question or concern you had? Please list any comments or questions not listed above?
   
 
 
 
Today's Date:
   
 
 
 
Your Name (Optional):
   
 
Please contact [email protected] or click here if you have any questions regarding this survey.
Survey Software Powered by QuestionPro Survey Software