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Dental Patient Satisfaction Survey
 
1) Age
Under 18
18 - 30
31 - 45
46 - 60
61 +
   
2) Gender
Male
Female
   
3) How often do you go to the dentist for check-ups?
Every 6 months
Once a year
Once every 2 years
Occasionally
Only when I have a problem
   
4) What was the purpose of your last visit?
Hygiene
Crown or Bridge
Implant
Facial Rejuvenation
Root Canal
Filling
Other
   
5) Which dentist did you see?
Rajan Sharma
Shivani Sharma
Yatin Nanavati
Margarita Kyrou
Marina Spanaki
Rupal Patel - Periodontist
Marie Fitt - Hygienist
   
6) Date of last visit:
   
7) Dentist Excellent Good Fair Poor N/A
Listens to you:
Takes enough time with you:
Clearly answers all your questions:
Comments
 
8) Waiting Excellent Good Fair Poor N/A
Time in waiting room
Time in surgery
 
9) Reception Excellent Good Fair Poor N/A
Friendly and helpfull
Answered any questions
If you answered 'fair' or 'poor' please provide further information:
 
10) Would you refer us to your friends and family? Maybe No
 
Name (You can return this anonymously if you prefer)
 
Date:
 
 
 
     
 
     
 
     
 
Castle Hill Dental Care
1c Tilehurst Road
Reading
RG1 7TW

Tel: 0118 958 6766

  
     
     
reading dentist
 
     
© 2011 castle hill dental care : All Rights Reserved, site last updataed 14/02/11
  

Castle Hill Clinic 1c Tilehurst Road Reading , Berks RG1 7TW United Kingdom Phone: 0118 958 6766 Email: Fax: 0118 950 9244

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