Patient Satisfaction Survey

How likely are you to recommend our dental practice to friends and family if they needed similar care or treatment?

First Choice
Second Choice
Third Choice

What attracts you to the Essex Smile Centre?

Comfortable and happy with dentist
Convenient location
Helpful well trained staff
Confident with quality of treatment
Improving Dental Health

How likely are you to recommend our dental practice to friends and family if they needed similar care or treatment?

Extremely likely
Likely
Neither likely not unlikely
Unlikely
Extremely unlikely
Don't know

How long have you been a member of the practice for?

Which dentist do you normally see?

What attracts you to the practice?

Comfortable and happy with dentist
Convenient location
Helpful well trained staff
Confident with quality of treatment
Improving dental health
Other

If other please specify.

Do you find staff at the practice professional and helpful?

Very good
Good
Satisfactoy
Poor

Do you find the staff at the practice professional and helpful?

Very good
Good
Satisfactory
Poor

How easy is it to make an appointment for your desired times?

Very easy
Sometimes difficult
Always difficult

Please give reasons why.

Do you feel you have been informed of new treatments/procedures/offers that we have at the practice?

All the time
Sometimes
Never

How confident are you that the dentist involves you in the decision making when completing your treatment plan options. Do you feel the options are explained to you clearly by the dentist?

All the time
Sometimes
Never

Are you happy with the cleanliness of the practice?

Very
Needs to improve
Not at all

Do you receive estimates for your treatment?

Yes
No

Did the estimates support what was explained to you by our dental staff?

Yes
No

Would you find it useful to receive regular newsletters from the practice?

Yes
No

We are currently accepting new patients at The Essex Smile Centre, would you recommend us to your family and friends?

Yes
No

Please specify your reasons.

Please indicate how you would like to receive your appointment reminders and dental recalls for oral health checks:

Email
Text message
Phone call
Letter

Are there any particular services you would like the practice to offer?

Do you have any other suggestions that you would like to put forward?

Would you like us to contact you regarding your suggestions?

Yes
No

Contact Name

Contact Telephone or Email:

Please select button below if you DO NOT want your comments to be made public.

Do not make public

Patient Satisfaction Survey

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