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1.How often does your child go to the dentist for checkups?
 
Every 6 months
 
Once a year
 
Once every 2 years
 
Occasionally
 
Only when they have a problem
 
 
 
2.What was the purpose of the visit?
 
Cleaning
 
Extraction
 
Filling
 
 
 
3.Who is your child’s primary dentist?
 
Dr. Singh
 
Dr. Kathi
 
Dr. Shoun
 
 
 
4.Ease of getting care
 
Ability to get in to be seen:
 
Hours Center is open
 
Convenience of Center’s Location
 
Prompt return on calls
 
 
 
 
5.Waiting
 
Time in waiting room
 
Time in exam room
 
Waiting for test to be performed
 
Waiting for test results
 
 
 
 
6.Dentist
 
Listens to you
 
Takes enough time with you
 
Explains what you want to know
 
Gives you good advice and treatment
 
 
 
 
7.Dental Assistants
 
Friendly and helpful to you
 
Listens to you
 
Takes enough time with you
 
Explains what you want to know
 
Gives you good advice and treatment
 
 
 
 
8.Receptionist and telephone staff
 
Friendly and helpful to you
 
Answers your questions
 
 
 
 
9.Charges / Billing
 
Cost of services
 
Explanation of charges
 
Collection of payment / money
 
 
 
 
10.Facility
 
Neat and clean building
 
Ease of finding where to go
 
Comfort and safety while waiting
 
Comfort of dental chair
 
Privacy
 
 
 
 
11.Would you consider the services provided equally balanced with the price of these services?
 
Yes
 
Maybe
 
No
 
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