How did you find out about our practice? How did you find out about our practice?WebsiteInternet SearchInternet SearchSchoolArea HealthPersonal RecommendationFamilyLocal DirectoryLocal DirectoryFacebookOther

Was the person who scheduled your appointment courteous and helpful? Was the person who scheduled your appointment courteous and helpful?YesNo

How would you rate the courtesy of the staff at the reception desk? How would you rate the courtesy of the staff at the reception desk?OutstandingGoodAdequateNeeds to ImprovePoor

How long did you wait in the reception area beyond your scheduled appointment time? How long did you wait in the reception area beyond your scheduled appointment time?5-15 minutes15-30 minutesLonger than 30 minutes

Mark the boxes that characterised the demeanour of your clinician. Mark the boxes that characterised the demeanour of your clinician. Attentive Concerned Friendly Distracted Rushed Inconsiderate

Please rate the clarity of the clinician’s explanation of your condition and treatment options. Please rate the clarity of the clinician’s explanation of your condition and treatment options. Outstanding Good Adequate Needs to improve Poor

Were your questions answered to your satisfaction? Were your questions answered to your satisfaction?YesNo

Mark the boxes that characterised the demeanour of your dental assistant. Mark the boxes that characterised the demeanour of your dental assistant. Attentive Concerned Friendly Distracted Rushed Inconsiderate

Mark the boxes that describe the suctioning technique of the dental assistant during treatment. Mark the boxes that describe the suctioning technique of the dental assistant during treatment. Comfortable Efficient Considerate Needs to improve Poor NA

Would you recommend this facility and its staff to your family and friends? Would you recommend this facility and its staff to your family and friends?YesNo

How would you rate our concern for your privacy? How would you rate our concern for your privacy?OutstandingGoodAdequateNeeds to ImprovePoorNA

Were your questions answered to your satisfaction? Were your questions answered to your satisfaction?YesNo

What did you like best about the practice?

What did you like least about the practice?

In what way(s) could we have made your experience better?

Additional comments (Please share any additional comments or suggestions)

Would you like someone to contact you regarding your responses on this survey? Would you like someone to contact you regarding your responses on this survey?YesNo

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