PATIENT SATISFACTION SURVEY

(Ratings 5=Highly Satisfied, 4=Satisfied, 3=Mostly Satisfied, 2=Partially Satisfied, 1=Not Satisfied)

* Type of Appointment: Dentist Appt. Hygiene Appt. Other	Name (not required):
1. Was it easy to schedule an appointment? Rating 5 4 3 2 1
2. Were you greeted in a friendly and prompt manner? Rating 5 4 3 2 1
3. Was your waiting time in the reception area reasonable? Rating 5 4 3 2 1
4. Was the Dentist/Hygienist sensitive to your needs? Rating 5 4 3 2 1
5. Was your treatment explained to your satisfaction? Rating 5 4 3 2 1
6. How would you rate the cleanliness and appearance of the facility. Rating 5 4 3 2 1
7. Was your treatment completed to your satisfaction? Rating 5 4 3 2 1
8. How would you rate your overall experience? Rating 5 4 3 2 1
9. Will you return to Alpha Dental Care for future treatment? Yes No
10. Would you refer a friend/family member to our practice? Yes No
How can we improve our patient care?

Thank you for taking the time to complete our survey.
We value your thoughts and opinions!