Patient Experience Survey
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1. Are you
Male
Female
Other
2. And what is your age
0 -15
16 -20
21-30
31 – 40
41 – 50
51 – 60
60 or over
3. How did you hear about us
Family/Friend
Signage
Practice Promotion
Print Media/Newspaper
Dentist Referral
Google
Existing Patient
Facebook/Instagram
Website
Other
4. How was the staff customer service and phone skills
5. How was the appearance and comfort of our waiting area
6. Which Practitioner did you see
Dr Jolvin Lee
Dr Akram
Dr Ben
Dr Wes
Thoa
Betty
Dr Jeff
7. Were you seen on time for your appointment
Yes
No
8. How well was your treatment explained to you during your appointment
9. How would you rate your overall experience with the practitioner and assistant in the treatment room
10. How likely are you to refer your family or friends to see us
I want to refer a friend/family.
11. It was easy to find parking
Yes
No
I didn't drive here
12. How would you rate this practice overall for cleanliness and tidiness of appearance
1- Poor
2- Needs Improvement
3- Acceptable
4- Good
5- Perfect
13. How preferred/convenient was the time you were able to book for your appointment
Not really
It was OK
Unsure
I don't mind
Perfect
14. How fair & reasonable would you say the fees are at this practice
1- Unreasonable
2- Reasonable but pushing it
3- Unsure
4- Cheap
5 - Fair and Reasonable
15. Did you find the information in the Goodie Bag helpful?
Yes
No
N/A
16. If you're here today for your 6 monthly active maintenance, if you could only pick one, what motivated you to come?
I get the a 10% off my next 6monthly maintenance visit
I like the Dentists / Therapists here
I like how the environment of Tooth Heaven makes me feel
I like everything about Tooth Heaven! It is the best clinic
Prices are reasonable here
I love the Latest Technology and Materials Tooth Heaven use
Does not apply
Can you please provide with feedback?
Submit
