Frances Anne Johnston DDS Dental Patient Satisfaction Survey Patient Satisfaction Survey We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. AgeUnder 1831-4546-6061+GenderMaleFemaleHow often do you go to the dentist for checkups?Every 6 monthsOnce a yearOccasionallyOnly when I have a problemWhat was the purpose of this visit?CleaningCrown/BridgeFillingOtherOther purpose for this visit (fill in):Which Dentist/Hygenist?Dr. Anne Johnston DDSOtherName of Hygenist seen:Rate your Level of SatisfactionEase of getting careAbility to get in to be seenExcellentGoodFairPoorN/AHours Center is openExcellentGoodFairPoorN/APrompt return of callsExcellentGoodFairPoorN/AWaitingTime in waiting roomExcellentGoodFairPoorN/ATime in exam roomExcellentGoodFairPoorN/AWaiting for procedures to be performedExcellentGoodFairPoorN/ADentistListens to youExcellentGoodFairPoorN/ATakes enough time with youExcellentGoodFairPoorN/AExplains what you want to knowExcellentGoodFairPoorN/AGives you good advice and treatmentExcellentGoodFairPoorN/ADental HygenistFriendly and helpful with youExcellentGoodFairPoorN/AListens to youExcellentGoodFairPoorN/ATakes enough time with youExcellentGoodFairPoorN/AExplains what you want to knowExcellentGoodFairPoorN/AGives you good advice and treatmentExcellentGoodFairPoorN/AReceptionist and Telephone StaffFriendly and helpful with youExcellentGoodFairPoorN/AGreeted you promptlyExcellentGoodFairPoorN/AAnswers you questionsExcellentGoodFairPoorN/ACharges/BillingCost of servicesExcellentGoodFairPoorN/AExplanation of chargesExcellentGoodFairPoorN/AExplanation of chargesExcellentGoodFairPoorN/AExplanation of Insurance BenefitsExcellentGoodFairPoorN/AFacilityNeat and clean buildingExcellentGoodFairPoorN/AEase of finding where to goExcellentGoodFairPoorN/AComfort while waitingExcellentGoodFairPoorN/AComfort of dental chairExcellentGoodFairPoorN/APrivacyExcellentGoodFairPoorN/AWould you refer us to your friends or relativesYesNoMaybeWhat do you like best about our office?What do you like least about our office?Suggestions for improvement?Anything we can do to make you appointment more pleasant and comfortable?General Comments
