Sierra Family Dentistry .:. Chandler, AZ Dentist offering professional dental care for Chandler and Phoenix, AZ area families.

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Now Accepting New Patients: 480-899-3425

Patient Satisfaction Survey...
We care what you think! Please take a few minutes to give us feedback about your most recent dental visit. Your comments will be strictly confidential. Thank you!

Section 1: About You / The Patient

Which member of the household visited the dentist?

	Male head of household
	Female head of household
	A child (under age 9)
	A child (age 10-17)
	A child age 17 or older (not head of household)

How often had this patient visited a dentist in the past year?

	Once or twice
	Three or four times
	Five or six times
	More than six times

In general, how would you rate your / the patient’s dental health?

	Excellent
	Good
	Fair
	Poor
	Don’t know

Who did you/the patient see primarily at this visit?

	Saw dentist primarily
	Saw hygienist primarily
	Saw both equally

What was the primary type of dental work performed on this visit?

	Preventative and diagnostic services: exam, cleaning or x-rays
	Basic services: fillings, extraction, root canal, periodontal care
	Major services: crowns, onlays, bridges, dentures, implants
	Cosmetic services: whitening, invisalign
	Other:

Section 2: About Your Visit

Please rate the following aspects of our dental practice:

Convenience of the office location to your home

Convenience of the office location to your work

Ability to get an appointment for routine dental care within a reasonable amount of time

Amount of time waiting in the office to see the dentist/hygienist

Ability to get an appointment for emergency dental care within a reasonable amount of time

Hours when the visit could be scheduled

Financial options presented to assist with payments as needed

Friendliness and courtesy of the front office staff

Cleanliness, appearance and comfort of the office

Please rate the quality of care you / the patient received:

Thoroughness of treatment by the dentist

The dentist’s ability to conduct the dental work as painlessly as possible

Friendliness and courtesy of the dentist

Friendliness and courtesy of the assistant

Friendliness and courtesy of the hygienists

The dentist’s sincere interest in your/the patient’s dental health

The dentist’s explanation of procedures that were conducted during the visit

The dentist’s explanation of procedures that may be needed in follow up visits

Opportunity to ask questions and have them answered

Overall care you received from the dentist

Overall care you received from the hygienist

What was the best part of your dental visit?

If you could change one thing about our dental practice, what would it be?

Is there anything else you would like us to know?

Thank you for participating in this survey! Your feedback allows us to improve our services to provide you with better service.