Short Survey for Website

PATIENT SATISFACTION QUESTIONNAIRE

We want to provide you with the very best possible personal care and service that meets your needs. To do this it is important that we know how you find the practice and the care we provide and to gain your views on where we can improve. We would be very grateful if you would spend five minutes completing this form.

PRACTICE’S GENERAL APPEARANCE

Very good / Good / Average /

Poor

Décor

State of repair/maintenance
Outside appearance

Cleanliness

RECEPTION:

Yes

No opinion

Are the reception staff helpful?

Are you dealt with efficiently at reception?

- On the phone

- At the desk before your appointment

- At the desk after your appointment

Were you greeted - on arrival?

- on departure?

Are the receptionists uniforms well presented?

Have you ever been kept waiting too long to see the dentist/hygienist?

Did you read our notice board?

All our fees are displayed on the notice board - is this helpful?

Was there enough room to sit?

Did you use our free Wi Fi facility?

DISABLED FACILITIES:

If you use our disabled facilities:

Yes

opinion
Were the disabled facilities satisfactory?

i.e: car parking, toilet, access etc

If no: What can we do to improve these facilities?

PHONES:

Yes / No / No Opinion
How long on average are you kept waiting before your call is answered? - answered immediately?
- within 30 seconds?
- within 1 minute?
- over one minute?
Were you happy with this response?
Was your phone enquiry answered to your satisfaction?

PRACTICE PERSONNEL

Dental Nurses

/ Yes / No /

No opinion

Are they friendly?

Caring?

Helpful?

Are they well informed?

Do they reassure you?

Dentists

How long did you wait for your appointment today?

0-5 minutes 5-15 minutes 15-30 minutes 30 + minutes
Yes / No / No opinion

Is your dentist helpful?

Caring?

Friendly?

Do they listen to you?

Do they explain enough to you?

Did the dentist answer all the questions you asked?

Did you feel that you were able to ask as many questions as you wanted?

Were you given treatment options? (If necessary)

Do you feel confident about the quality of treatment they are providing for you?

Were your fees for treatment discussed with you?

Were you given preventative advice for your

gums / teeth: - Today?

- In the past?

Were you given dietary advice for you / your

family: - Today?

- In the past?

Are you a smoker?

If yes: were you given advice about not smoking?

During your examination (if applicable) all soft tissues are checked for early signs of cancer / fungal infections or any other conditions. Are you aware of this?

Do you prefer your teeth to be cleaned by:
a Dentist?
or a Hygienist?
In your opinion, does your dentist know enough about your medical history?
Would you like to change your dentist?
If yes: Who would you like to change to?

Dental Hygienists

How long did you wait for your appointment today?

0-5 minutes 5-15 minutes 15-30 minutes 30 + minutes

Yes / No /

No opinion

Are they friendly?

Caring?

Helpful?

Are they well informed?

Do they reassure you?

Were you shown how to use an electric toothbrush?

Were you shown how to use a manual toothbrush?

Were you shown how to floss your teeth?

Were you shown how to use Tepe brushes?

Were you shown how to use plaque disclosing tablets?

Were hand scalers used during your appointment?

Was Prophy Jet (white powder spray with water) used during your appointment?

Was the ultra sonic scalar used during your appointment?

Were you given preventative advice on how to avoid gum disease?

Were you given an explanation on how gum disease occurs?

Do you understand what 'Plaque' is?

Do you understand what 'Calculus' is?

Do you understand what 'Tartar' is?

Do you understand what 'Gum Pocket' is?

COMPLAINTS

Yes / No / No
Opinion
Do you know about the practice complaints procedure?
Do you feel that the practice welcomes complaints?
Have you complained in the past?
If yes, was the complaint dealt with to your satisfaction?
Do you know who deals with complaints?

PAYMENT FOR TREATMENT

Yes / No / No
Opinion
Do you feel that the cost of treatment was fully explained?
Would you like to have a written estimate for the proposed treatment?
Do you think that the practice’s private charges are value for money for the preventative care including hygienists, quality of care from all our staff, high tech diagnostic equipment including digital xrays, out of hour care, early morning, late evening and Saturday appointments and the quality of the premises and furnishings, we provide?
Patients fees are due at the end of each appointment - Do you prefer to settle your fees:
On the day?
Within a week of treatment completion?
Within a month of treatment completion?
A mixture of all above?
Would you prefer to pay:
By Cash?
Cheque?
Credit Card?
Instalments?
Did you know you can pay by a monthly payment plan under our Dental Plan Direct Ltd scheme.
See reception for more details.
Are you part of our Dental Plan Direct Ltd scheme?

WHAT ATTRACTS YOU MOST ABOUT THE PRACTICE?

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WHAT DO YOU LIKE LEAST ABOUT THE PRACTICE?

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ANY OTHER COMMENTS OR SUGGESTIONS:…………………………………………………………………………………………

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