Patient Satisfaction Questionnaire

Patient Satisfaction Survey

Dear Patient,

Please help us to ensure that we provide you with the best possible service, by completing this questionnaire. Tick the box in the corresponding column to let us know what you think about our practice and service. This is completely anonymous and any information you provide will be treated in the strictest confidence.

  • 1 = Poor
  • 2= Below Average
  • 3 = Average
  • 4= Above Average
  • 5 = Excellent
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1. General Service
The practice opening hours 1 2 3 4 5
The practice layout and accessibility 1 2 3 4 5
Patient information such as leaflets, brochures and signs 1 2 3 4 5
The supply of retail products such as toothpaste, toothbrushes and floss 1 2 3 4 5
Cleanliness and tidiness of the practice 1 2 3 4 5
 
2. Our Practice Arrangements
The entrance of the practice 1 2 3 4 5
The layout of reception 1 2 3 4 5
The patients’ toilet 1 2 3 4 5
The treatment room 1 2 3 4 5
The overall impression of the practice 1 2 3 4 5
 
3. Customer Care
Staff professionalism 1 2 3 4 5
Our telephone manner 1 2 3 4 5
Staff uniforms and general appearance 1 2 3 4 5
How welcomed you felt 1 2 3 4 5
How friendly the staff were 1 2 3 4 5
 
4. Our Dentists
Did you feel confident with the orthodontist 1 2 3 4 5
How clearly were treatment choices explained 1 2 3 4 5
How relaxed did you feel during treatment 1 2 3 4 5
How comfortable was the treatment 1 2 3 4 5
 
5. Administration And Finance (if applicable)
How clear was the estimate and treatment plan, given before treatment started 1 2 3 4 5
Was the treatment good value for money 1 2 3 4 5
Were your charges collected professionally 1 2 3 4 5
 
6. Appointments
How satisfied were you with appointment times 1 2 3 4 5
Were your appointments usually on time 1 2 3 4 5
Ease of getting emergency appointments 1 2 3 4 5

Thank you for taking the time to fill out this questionnaire