Your Name (Optional, but it helps us direct your praise or criticism to relevant members of the team)
First Name
Last Name
How did you make your initial appointment?
Please Select
I walked in
I called up
Through the website
I sent an email
How easy was it for you to make an appointment?
1
2
3
4
5
Very difficult
Very Easy
1 is Very difficult, 5 is Very Easy
How quickly did our office team help you with your enquiries?
1
2
3
4
5
Very slowly
Very quicly
1 is Very slowly, 5 is Very quicly
How knowledgable were our office staff?
1
2
3
4
5
Clueless
Very knowledgable
1 is Clueless, 5 is Very knowledgable
How friendly were our office staff?
1
2
3
4
5
Unfriendly
Very friendly
1 is Unfriendly, 5 is Very friendly
Did you see a dentist at DS Dental Studio?
Yes
No
Dentists
Did your dentist spend too much time with you, too little, or about the right amount of time with you?
1
2
3
4
5
Too much
Too little
1 is Too much, 5 is Too little
How much did you trust your dentist to suggest treatments that are in your best interests?
1
2
3
4
5
Trust little
Trust completely
1 is Trust little, 5 is Trust completely
How helpful was your dentist at explaining your dental needs?
1
2
3
4
5
Not at all helpful
Extremely helpful
1 is Not at all helpful, 5 is Extremely helpful
Overall, are you satisfied with your dentist?
1
2
3
4
5
Extremely unsatisfied
Completely
1 is Extremely unsatisfied, 5 is Completely
How likely are you to recommend your dentist to family or friends?
1
2
3
4
5
Not likely
Very likely
1 is Not likely, 5 is Very likely
Did you see a hygienist during your course of treatment?
Yes
No
Hygienists
How helpful was your hygienist at explaining your oral hygiene needs?
1
2
3
4
5
Not at all helpful
Extremely helpful
1 is Not at all helpful, 5 is Extremely helpful
How happy were you with your dental hygiene treatment?
1
2
3
4
5
Very unhappy
Very pleased
1 is Very unhappy, 5 is Very pleased
Did your hygienist recommend enough products for you to improve your oral hygiene?
1
2
3
4
5
Not enough
Too much
1 is Not enough, 5 is Too much
No hygiene
The reason you didn't see a hygienist?
I couldn't afford it
I have an appointment coming up / will book one
I was not due to see one
I was not recommended to see one
Other
Please specify
Any other comments?
Your comments and views are much appreciated
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