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Patient Satisfaction Survey
Tell Us What You Think About Our Practice So We Can Serve You Better!
Name:
(optional)
1. How do you feel when you are greeted by our front office staff?
welcomed
hurried
comforted
appreciated
unimportant
2. How do you feel when you are greeted by our clinical staff when brought in from the waiting room?
welcomed
hurried
appreciated
comforted
apprehensive
3. When you get your teeth cleaned, how do you feel about the care you receive?
hurried
rough
thorough
gentle
caring
4. What is your impression of Dr. Kearney and the care he provides?
hurried
thorough
rough
caring
gentle
5. What is your impression of the care the dental assistant provides in the absence of the dentist?
hurried
caring
rough
thorough
gentle
6. How do you feel about your communication with Dr. Kearney?
he understands me
he seems preoccupied with something other than me
he listens to me
he makes me feel that my concerns are important to him
he makes me feel unimportant
7. How do you feel about your communication with Dr. Kearney’s staff?
they understood me
they are preoccupied with something other than me
they listened to me
my concerns are important to them
they make me feel unimportant
8. What is your overall impression of Dr. Kearney’s dental practice?
caring
up to date
thorough
not up with the times
the type of practice where you want to refer your family and friends
9. Have we addressed all of your concerns to your satisfaction?
yes
no
If no, please explain:
