Duston Dental Practice Satisfaction Survey 2016

Dear Patient,

please could you spare us a few minutes of your time in order to complete a customer satisfaction survey. Doing so will help us to improve our practice and our service to you.

All responses received are anonymous.

Thank you in anticipation of your help

Richard Staincliffe

Duston Dental Practice

1. Please indicate your age range

2. Please indicate your gender

Male
Female
Other

3. How long have you been a patient at Duston Dental Practice?

First visit
0-6 months
6-12 months
12 months+

4. How did you hear about Duston Dental Practice

5. Which dentist or hygienist do you normally see (tick all that apply)?

6. How would you rate the following aspects of your most recent visit to Duston Dental Practice?

	Excellent	Good	Adequate	Poor	Very poor
Helpfulness of reception staff	Helpfulness of reception staff Excellent	Helpfulness of reception staff Good	Helpfulness of reception staff Adequate	Helpfulness of reception staff Poor	Helpfulness of reception staff Very poor
Helpfulness of nursing staff	Helpfulness of nursing staff Excellent	Helpfulness of nursing staff Good	Helpfulness of nursing staff Adequate	Helpfulness of nursing staff Poor	Helpfulness of nursing staff Very poor
Pain control	Pain control Excellent	Pain control Good	Pain control Adequate	Pain control Poor	Pain control Very poor
Care and attention shown by your dentist	Care and attention shown by your dentist Excellent	Care and attention shown by your dentist Good	Care and attention shown by your dentist Adequate	Care and attention shown by your dentist Poor	Care and attention shown by your dentist Very poor
Explanation of treatment costs and options	Explanation of treatment costs and options Excellent	Explanation of treatment costs and options Good	Explanation of treatment costs and options Adequate	Explanation of treatment costs and options Poor	Explanation of treatment costs and options Very poor
Practice opening hours	Practice opening hours Excellent	Practice opening hours Good	Practice opening hours Adequate	Practice opening hours Poor	Practice opening hours Very poor
Availability of routine appointments	Availability of routine appointments Excellent	Availability of routine appointments Good	Availability of routine appointments Adequate	Availability of routine appointments Poor	Availability of routine appointments Very poor
Availability of emergency appointments	Availability of emergency appointments Excellent	Availability of emergency appointments Good	Availability of emergency appointments Adequate	Availability of emergency appointments Poor	Availability of emergency appointments Very poor
Waiting time for your scheduled appointment	Waiting time for your scheduled appointment Excellent	Waiting time for your scheduled appointment Good	Waiting time for your scheduled appointment Adequate	Waiting time for your scheduled appointment Poor	Waiting time for your scheduled appointment Very poor
Practice hygiene	Practice hygiene Excellent	Practice hygiene Good	Practice hygiene Adequate	Practice hygiene Poor	Practice hygiene Very poor
Building access	Building access Excellent	Building access Good	Building access Adequate	Building access Poor	Building access Very poor

7. Are there any other comments which you would like to make about Duston Dental Practice?

Use our survey software to make a survey.