PATIENT SATISFACTION SURVEY

Dear Patient,

In order for us to serve you better, we would like your comments regarding our performance. Please complete this survey knowing that your responses will be kept confidential.

1. How were you received by the receptionist?

2. Overall performance by the front office personnel

3. How long did you wait to be seated? (please select one)

4. How were you treated by the chairside assistant?

5. How would you rate the care you received from your dentist?

6. How clearly was your treatment plan explained to you?

7. How comfortable and confident were you with your dentist?

8. How concise and clear was your financial arrangement?

9. How comfortable would you be referring your family and friends?




Prosthodontist - Concord, Pleasant Hill, Walnut Creek, Antioch - Dental Specialty Group, 1255 Willow Pass Rd, Concord CA, 94520 (925) 680-4444