Patient Satisfaction Survey
Patient Satisfaction Survey
for ODU's Dental Hygiene Care Facility
Please rate your experience:
Please rate your experience:
Excellent
Very Good
Average
Below Average
Poor
Faculty were involved and helpful.
Faculty were involved and helpful.
Excellent
Faculty were involved and helpful.
Very Good
Faculty were involved and helpful.
Average
Faculty were involved and helpful.
Below Average
Faculty were involved and helpful.
Poor
Staff were courteous and helpful.
Staff were courteous and helpful.
Excellent
Staff were courteous and helpful.
Very Good
Staff were courteous and helpful.
Average
Staff were courteous and helpful.
Below Average
Staff were courteous and helpful.
Poor
Concern for my welfare was:
Concern for my welfare was:
Excellent
Concern for my welfare was:
Very Good
Concern for my welfare was:
Average
Concern for my welfare was:
Below Average
Concern for my welfare was:
Poor
Student was prepared and knowledgeable.
Student was prepared and knowledgeable.
Excellent
Student was prepared and knowledgeable.
Very Good
Student was prepared and knowledgeable.
Average
Student was prepared and knowledgeable.
Below Average
Student was prepared and knowledgeable.
Poor
Cleanliness of the treatment area and reception room were:
Cleanliness of the treatment area and reception room were:
Excellent
Cleanliness of the treatment area and reception room were:
Very Good
Cleanliness of the treatment area and reception room were:
Average
Cleanliness of the treatment area and reception room were:
Below Average
Cleanliness of the treatment area and reception room were:
Poor
Overall, today's appointment was:
Overall, today's appointment was:
Excellent
Overall, today's appointment was:
Very Good
Overall, today's appointment was:
Average
Overall, today's appointment was:
Below Average
Overall, today's appointment was:
Poor
Would you recommend this facility for preventive oral care?
Would you recommend this facility for preventive oral care?
Yes
No
Date of Visit
Date of Visit
/
MM
/
DD
YYYY
Comments
Spam Protection. Please answer this simple question.
2, 24, 8, 1 : which of these is the largest?