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Patient Satisfaction Survey

Children & Adult Dentistry - Fort Myers, FL

Please choose the dental care provider seen during your most recent visit at our Fort Myers, FL location:

Please choose the response that best reflects your answer based on the rating scale below:

1 = Always 2 = Sometimes 3 = Never

1. Is it easy to make an appointment?

123

2. Do we answer the phone promptly and politely?

123

3. Does the receptionist check back within an appropriate time when kept on hold?

123

4. Do we return your calls promptly?

123

5. Are you greeted pleasantly upon arrival?

123

6. Is our reception area clean and comfortable?

123

7. Do we see you on time?

123

8. Does our staff seem genuinely interested in you?

123

9. Are our exam rooms clean and comfortable?

123

10. Are you treated with compassion and respect?

123

11. Does the doctor and staff spend sufficient time with you?

123

12. Are the doctor and staff attentive to your needs and concerns?

123

13. Are all of your questions answered satisfactorily?

123

14. Do you receive satisfactory instructions to your questions regarding prescribed treatment and medication, if applicable?

123

15. Do we give you complete information regarding insurance coverage, copayments and fees?

123

16. In an emergency, is it easy for you to get in touch with our office?

123

Are there any areas in communication or treatment you feel we could improve upon?

YesNo

If so, what?

Do you feel confident referring your friends, family members or colleagues to our practice?

YesNo

Why?

Are our office hours convenient for your schedule?

YesNo

If not, what hours would be more convenient?

Is our office easy to find?

YesNo

If there were one thing we could do to improve our quality of care or service, what would it be?

If there are any other comments or concerns you would like to share with us, please use the space provided.

May we use any of your comments in print and/or on our website?

YesNo

Thank you for taking the time to complete this survey. Your feedback is very valuable to us!

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