Dental Patient Satisfaction Survey

Admin Console

Your feedback is valuable to us!

Your response hasn't been recorded, please contact the survey administrator.

Your response cannot be recorded as some of the field validations take longer time to execute. We'd suggest resubmission before contacting the survey administrator for assistance.

Decimal values aren't allowed Only numeric values are allowed {0} shouldn't exceed {1} characters {0} shouldn't exceed {1} characters Please enter a valid email address Please enter the date in DD/MM/YYYY format Please enter the date in MM/DD/YYYY format Please enter the date and time in DD/MM/YYYY HH:MM AM/PM format Please enter the date and time in MM/DD/YYYY HH:MM AM/PM format Please enter the date in DD MMM YYYY format Please enter the date in MMM DD, YYYY format Please enter the date and time in DD MMM YYYY HH:MM AM/PM format Please enter the date and time in MMM DD, YYYY HH:MM AM/PM format Please enter the date in YYYY/MM/DD format Please enter the date in YYYY MMM DD format Please enter the date and time in YYYY/MM/DD HH:MM AM/PM format Please enter the date and time in YYYY MMM DD HH:MM AM/PM format Please select a date in between {0} and {1} Please select a date after {0} Please select a date before {0} Please enter a number between {0} and {1} Please enter a number larger than {0} Please enter a number smaller than {0} Text must be between {0} and {1} characters File name should be less than 150 characters File name should have at least 1 character Allowed file extensions are {0} File size must be less than {0} File size should not be 0 File size must be between {0} and {1} Please upload exactly {0} file(s) Please upload files between {0} and {1} File limit should not exceed {0} Your file name can't contain the characters (* | / ; & < > " ?) Name can't exceed 100 characters Signature can contain only letters and the following special characters (.()-_;) File size can't exceed 10 MB Tap over the highlighted items to view the errors Text must be between {0} and {1} characters Some items have the same ranking The {0} survey is loading. {0} out of {1} responses have not been uploaded. This could be due to changes made in the survey by the administrator. Please enter valid content out of {{sum}} If you click {0}, your location will be shared with this application's owner on submitting this form

You can use this unique link to come back and fill in your survey anytime

Survey link

Get notified

Enter your email address to receive the unique survey link via email

0

Have you visited our oral care center?
Yes

No
0

How did you hear of us?
Friend/relative

Television advertisement

Leaflets/brochures

Newspaper

Posters

Other (Please specify)
0

How many times have you visited us previously?
This is my first time

Only once

More than once

I visit [center's name] for all my dental needs

Only when my personal dentist is unavailable
0

What is the name of the dentist who treated you?
0

How satisfied are you with the dentist's attitude and behavior?
Very satisfied

Somewhat satisfied

Neutral

Somewhat dissatisfied

Very dissatisfied
0

Rate the following based on your satisfaction:

Cleanliness

Restrooms

Staff behavior
0

How professional was the dentist in his/her work?
Not at all

Slighty

Moderately

Very

Extremely
0

Do you have any individual comments to the dentist?
0

How can we improve our services?