The Endodontic Practice
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Patient Survey
Welcome to our practice, if you would like to fill in this patient survey. 1. How easy and convenient was it to make an appointment?
Very Easy
Fairly Easy
Not Easy
2. We aim to see all patients within 15 minutes. How long did you have to wait today before you were seen?
I didn’t have to wait
Between 15 and 30 minutes
Longer than 30 minutes
3. During your visit, were you treated professionally and respect by our staff?
Yes at all times
Mostly
No, Not at all
4. We hope to always show and fully explain any suggested treatments and to give you plenty of time and opportunity to ask questions. How satisfied are you that we succeeded?
Very satisfied
Fairly satisfied
Not Satisfied
5. It is our policy to provide all patients with a detailed treatment plan and costs before any treatment starts. How satisfied are you with the information given to you about the cost of your treatment?
Very satisfied
Fairly satisfied
Not Satisfied
6. How satisfied are you with the outcome of your treatment?
Very satisfied
Fairly satisfied
Not Satisfied
7. How likely are you to recommend our practice to family and friends?
I already have recommended
Quite likely
Not likely
8. Have we got it right or how can we improve? Please write a few things that you think we should improve or what you like about our practice:
Please contact me about my comments and suggestions
Would you like us to respond to you? If so give your contact details here:
Your name
Your email address
Your telephone number
Thank you for you for taking this opportunity to give us your views. You can either email this or post it to us.
