Dental Questionnaire Template

Struggling to find the right questions? Pressed for time? Use this dental patient survey template to get started quickly.

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Number of questions

11

Time to complete

8 minutes

Customisable?

Yes

Dental patient survey questions in this example

To get you started quickly, this example questionnaire comes pre-populated with common questions you may wish to ask dental patients. The provided questions cover matters relating to oral health and dentist visits and can be quickly and easily amended, with questions added or removed, to meet your exact needs. Other question types are available, and our survey templates can be styled to reflect the identity of your practice.

Do you have a regular dentist?

‘Yes/No’ question.

How did you come across your dentist?

Multiple choice question with single-select answer.

Do any family members use the same dentist as you?

Multiple choice question with single-select answer.

What would you say is the most likely reason for skipping the dentist?

Multiple choice question with single-select answer.

When was the last time you attended the dentists?

Multiple choice question with single-select answer.

How often do you require a check up?

Multiple choice question with single-select answer.

Are you notified when it is time for check up?

‘Yes/No’ question.

How are you notified when it is time for a check up?

Multiple choice question with single-select answer.

How do you normally pay for the dentists?

Multiple choice question with single-select answer.

What do you like the most about visiting the dentists?

Free-form answer box.

What suggestions, if any, do you think would improve your dentists?

Free-form answer box.

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