Willow Springs Dental Care

Satisfaction Index Survey

(5-1 scoring, 5 = highly satisfied, 1 = not satisfied)

Your Name:

Your Email:

Survey is for:

Question:

1. Was it easy to schedule a convenient appointment?

5 4 3 2 1

2. Were you greeted in a prompt and friendly manner?

5 4 3 2 1

3. Was the dentist and/or hygienist sensitive to you needs?

5 4 3 2 1

4. Was you waiting time in the reception are reasonable?

5 4 3 2 1

5. Was your treatment explained to your satisfaction?

5 4 3 2 1

6. How would you rate the cleanliness at the dentist facility?

5 4 3 2 1

7. Was your dental treatment completed to your satisfaction?

5 4 3 2 1

8. How would you rate your overall experience?

5 4 3 2 1

Yes/No Answers

9. Would you return to our dental practice for the future treatment?

Yes No

10. Would refer a friend to our dental practice in the future?

Yes No

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