Patient Feedback Survey

At Creve Coeur Dental we are constantly trying to improve the services we deliver to you.
Please take a moment to rate each item.

Your Feedback is Important to us and does help make our office a better place for our patients and staff.

 

Your Name

Your Email

KEY:
Please rate the following categories with 5 indicating highly satisfied and 1 indicating highly dissatisfied. Additional comments are encouraged as we use them as a tool for achieving excellence.

 

1. Was it easy to schedule a convenient appointment?
54321

 

2. How friendly, understanding, and warm did you find the administrative team when making your appointment?
54321

Who booked your appointment?

 

3. When you arrived at our office, were you greeted in a prompt and friendly manner?
54321
 

4. Were you seated and seen in a timely fashion?
54321
 

5. How pleased were you with your dental assistant’s performance and communication skills during the visit?
54321

Who was your dental assistant?

 

6. How satisfied were you with your hygienist and the dental cleaning performed?
54321
 

7. Was the dentist considerate and sensitive to your needs?
54321
 

8. How would you rate our explanation of patient financial obligations and responsibilities?
54321
 

9. How would you rate our administrative team’s customer service?
54321
 

10. How would you rate the cleanliness of the dental facility?
54321
 

11. How likely are you to return to our dental practice for future dental needs?
54321
 

12. How likely are you to refer a friend to our dental practice in the future?
54321
 

Additional Comments

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