Patient Satisfaction Survey Instructions: Please answer the following questions and rate the services you received at our office. Check the box that best describes your experience. If you did not receive a service then leave that question blank and go to the next question. Please include any additional comments you may have. Thank you for your time and for sharing your feedback with us. It is important to us and will help us continue to provide the highest level of dental services to our patients. *Patient Name: *Email: *Date of Visit: Is someone other than patient completing survey? Yes No If yes, what is your relationship to patient? Category Extremely Dissatisfied 1 Dissatisfied 2 Fair 3 Satisfied 4 Extremely Satisfied 5 Ease of scheduling your appointment Courteously/friendliness of front office staff Comfort/pleasantness of waiting area Time spent waiting before going into an exam room Sensitivity/concern the staff showed for your questions and concerns Friendliness/courtesy of Dr. Hutt Explanations Dr. Hutt provided you about your treatment Instructions Dr. Hutt gave you about your follow-up Amount of time Dr. Hutt spent with you The value of services compared with the actual cost Overall satisfaction/rating of care with your visit to Hutt Dentistry Probability you would recommend Hutt Dentistry to others What dental services are you interested in/considering? (Check all that apply) Teeth Whitening Invisalign (invisible braces) Extractions & Root Canal Therapy Sedation Dentistry Veneers & All Porcelain Crowns Dentures with No Metal Clasps Implant Restoration Other   © Copyright 2012 Steven Hutt All Rights Reserved. Site designed and maintained by HCP marketing.