Patient Survey

It is our goal to provide our patients and families with the highest quality of care possible. This questionnaire has been designed to help us evaluate our services. You will be helping us greatly by taking a few minutes to complete this survey. All information is confidential and your candor is appreciated.
Required*

Please rate statements below from 1 to 5, where 1 is Strongly Disagree and 5 is Strongly Agree:
  • The reception area is comfortable and attractive. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The office is always clean. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The staff is well groomed. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The doctor and staff are always courteous. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • Hygiene is taught and emphasized. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • Incoming calls are answered promptly. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The doctor and staff answer all of my questions satisfactorily. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The doctor and staff are gentle and caring. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The receptionist is cheerful and cooperative in making appointments. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The doctor and staff keep me informed of treatment progress. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The doctor and staff are skillful in performing their tasks. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • I believe I am (my child is) receiving excellent care. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • The practice appears organized and efficient. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE

 

  • I am normally seen on time. *

       1  2  3  4  5  
    Strongly DISAGREE Strongly AGREE
Optional Questions:
  • What do you like best about our office?

  • What do you like least about our office?

  • Are there any staff members you would like to acknowledge for excellent service?

  • Would you recommend our office and services to your friends and relatives?

  • Use this space for additional comments or to expand on any of your answers.

  • Patient Name (optional)
    If you'd like to provide us with the patient's name, we would be happy to add 10 points to his/her Patient Rewards Hub account.