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2014
August
S
Simply Smiles, P.A. Patient Satisfaction
Simply Smiles, P.A. Patient Satisfaction
Simply Smiles, P.A. Patient Satisfaction Survey
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Hello:
You are invited to participate in our survey Simply Smiles, P.A. Patient Satisfaction Survey. In this survey, our patients will be asked to complete series of questions about our dental office. It will take approximately 5 minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Dr. Angela Boehler Homoky at 941-625-5141 or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
I Agree
How long have you been a patient of Simply Smiles, P.A.?
New Patient (First Visit)
<1 year
1-5
over 5 years
How long did you have to wait to be seated at your last appointment?
No wait
5-10 min
10-15 min
> 15 min
How satisfied were you with your last appointment?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with the following:
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Services offered
Fee for services
Atmosphere
Quality of Services performed
How satisfied are you with our hygiene department?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with our front office staff?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with our dental assistants?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with our doctor?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
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