1.
When I called the office:
You
picked up right away
I
got a busy signal
It
was a struggle to get through
I
was put on hold
I
was put on hold forever
I
got an answering machine
2.
The person who answered was:
Cheerful,
professional
Impatient
Downright
unpleasant
Bored
with the whole thing
Unable
to help me
3.
About appointments:
There
were plenty of good dates
I
was appointed at a convenient time for me
I
had an emergency - you saw me right away
You
were booked for months
I
took what I could get
4.
Arriving here:
You
were easy to get to
Your
staff had a friendly hello
I
couldn't park nearby
I
was ignored
5.Our
reception room was:
Comfortable
Pleasant
Nice
and neat
Noisy
Too
crowded
6.
How long did you sit before you
were seated for treatment?
I
was seen right away
The
wait was tolerable
I
was informed how long it would be
It
wasn't your fault, I was late
Too
long, very irritating
7.
The treatment room
It
was spotless
The
equipment is pretty impressive
It
needed attention
It
seemed worn and outdated
It
was too hot/cold
8.
During my cleaning, the hygienist:
Was
professional, helpful
Was
thorough and concerned
Was
a little rough on me
Was
distant
Raced
through treatment
N/A
I was seen by the dentist only
9.The
hygienist:
Answered
all my questions
Reinforced
homecare techniques
Seems
to really care
Praises
me when I am doing something right
Lectured
me
N/A
I was seen by the dentist only
10.
The chairside assistant:
Was
professional and helpful
Did
everything to make me comfortable
Was
a little rough
Couldn't
care less
Was
rushed
11.
The doctor and the assistant:
Worked
as a team
Worked
quickly, smoothly
Cared
about my comfort
Ignored
me
Didn't
get along
12.
The doctor:
Was
professional, pleasant
Was
really quite gentle and concerned
Was
rough
Didn't
seem to have his/her heart in it
Was
in a hurry
13.
More about the doctor:
Seems
interested in people, not just patients
Really
listens
Explained
everything he was doing
Had
no time for my questions
I
didn't understand what he/she said
14.
A little more :
The
doctor keeps up with what's new
He
likes to try out new treatments
I
don't know, he seems a little old-fashioned
The
doctor involves me in my own treatment
I
have no way of knowing how good he is
15.
The office staff:
Seems
to work well together
Seems
to enjoy what they're doing
Really
do care
Are
neat, professional
Don't
take enough time with me
16.
About financial matters:
Fees
& payments were thoroughly discussed
Fees
are fair, considering
We
agreed on an arrangement
I
was confused about my obligation
Your
approach made me feel uncomfortable
17.
About my insurance:
You
make it easier to file my claim
Staff
was very helpful explaining my coverage
Insurance
processing seems to work well
No
one could help me understand my coverage
I
didn't like the way I was handled
18.
How I heard about you:
I
was referred by a relative/friend
Another
healthcare professional
I
saw your ad in the yellow pages
I
saw another advertisement
I
saw your office sign
Through
the Internet
I
purchased a silent auction coupon
Other:
19 .
If I were to rate the practice in a scale of 1 to 10 (10
being the highest rating), I'd give the doctor, practice and
staff a
10
9
8
7
6
5
4
3
2
1
.
20 .
One of the things I like best about your practice:
.
21 .
But you could improve on:
.
22 .
What services would you like to see added to our practice?
.
Thank you so
much for completing our survey - your opinion counts!
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J. Eric Hibbs, DDS, FAGD