Dental Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.
Your response are directly responsible for improving the quality of care given.
All responses will be kept confidential and anonymous.

    Age:

    Under 1818-3031-4546-6061+

    Gender:

    MaleFemale

    Who did you see today?

    Dr. Anthony (Dentist)Dr. Mariella (Dentist)Madeline (OHT)Chiara (OHT)

    What was the purpose of your visit today?

    Gum Care (OHT)FillingRoot Canal TreatmentCrownOther

    How often do you visit the dentist?

    Every 6 monthsOccasionallyOnly when I have a problem

    Waiting:

    Seen on timeWaited less than 5 minutesWaited longer than 15 minutes

    Ease of getting care

    Ability to get in to be seen:

    ExcellentGoodFairPoorN/A

    Hours we are open:

    ExcellentGoodFairPoorN/A

    Dentist

    Listens to you:

    ExcellentGoodFairPoorN/A

    Explains your treatment:

    ExcellentGoodFairPoorN/A

    Explains further treatment:

    ExcellentGoodFairPoorN/A

    Explains what you want to know:

    ExcellentGoodFairPoorN/A

    Hygienist

    Listens to you:

    ExcellentGoodFairPoorN/A

    Explains your treatment:

    ExcellentGoodFairPoorN/A

    Gives you good advice:

    ExcellentGoodFairPoorN/A

    Explains further treatment:

    ExcellentGoodFairPoorN/A

    Front Office

    Friendly and helpful to you:

    ExcellentGoodFairPoorN/A

    Answers your questions:

    ExcellentGoodFairPoorN/A

    Facility

    Neat and Clean:

    ExcellentGoodFairPoorN/A

    Comfort and safety while waiting:

    ExcellentGoodFairPoorN/A

    Comfort of dental chair:

    ExcellentGoodFairPoorN/A

    Privacy:

    ExcellentGoodFairPoorN/A

    Dental Assistant

    Friendly and helpful to you:

    ExcellentGoodFairPoorN/A

    Listens to you:

    ExcellentGoodFairPoorN/A

    Explains further treatment:

    ExcellentGoodFairPoorN/A

    Would you refer us too your friends or relatives?

    YesMaybeNo

    What do you like best about Adelaide Dental Solutions?

    What do you like least about Adelaide Dental Solutions?

    Suggestions for improvement: