Patient Survey – Oak Harbor Pediatric Dentistry

Thank you, for choosing our dental practice to help you maintain good oral health. We appreciate your trust and confidence in us. We are here to render caring, quality dental care, promptly and professionally, in a pleasant and friendly atmosphere. We put our patients first in all we do. We appreciate you taking the time to complete our survey. We aspire to consistently maintain high standards of excellence and patient satisfaction. Your input will help us improve and serve you better. Any comments you make are kept strictly confidential and can only help us become better.

Doctor's Name*

Patient Name

Email

How would you rate your visit overall?*

Excellent
Adequate
Poor

Were you greeted when you arrived?*

Yes
Not really
I don't recall

Was the receptionist helpful?*

Yes
Not Really
Not At All

Were you seen by the dentist in a reasonable amount of time?*

Yes
No

How long was the wait?*

15-30 minutes
30-45 minutes
Over 45 minutes

Were your financial options explained to you?*

Yes
No
No I already understand my financial options

Did you understand the cost before the treatment was started?*

Yes
No
Not really

How was the quality of care?*

Excellent
Adequate
Poor

Did your dentist manage your Discomfort?*

Yes
Not Really
I am still in a lot of pain

Was the assistant helpful and courteous?*

Yes
Not Really
No

How was your cleaning?*

Excellent
Adequate
Poor

How would you rate the Cleanliness of our office?*

Excellent
Adequate
Poor

When your appointment was over, did you have a good understanding of your dental situation?*

Yes
Not really
I wish I knew more about my situation

Would you recommend your friends and family to us?*

Yes
No
Not sure

What can we do to improve and make your next visit better?