Dental Patient Satisfaction Questionnaire


A Dental Patient satisfaction questionnaire reveals whether a patient has faced any problems during dental treatment or if they are satisfied with the dental care and other related services provided by their dentist. The Dental Patient satisfaction questionnaire is filled by a patient and this survey is either conducted by the hospital or dental clinic or even by government and private agencies.

Dental Patient Satisfaction Questionnaire Sample

Name of the Individual: ____________________________________ Date: _____________

Sex: __________  Age: ___________  Marital Status: _______________

Address: ___________________________________________________

City: ________________ State: ______________  Zip: ______________

Telephone: ____________________  Email: ________________________

Date of last dental checkup: _____________________________________

Q1. How satisfied are you with your current dental care?

a)   Very satisfied

b)   Satisfied

c)   Neutral

d)   Dissatisfied

e)   Very Dissatisfied

Q2. How would you rate the assistance at the clinic reception?

a)   Prompt and helpful

b)   Helpful but I had to ask

c)   Slow and uncaring

d)   Rude

Q3. How would you rate the assistance of dental staff?

a)   Prompt and helpful

b)   Helpful but I had to ask

c)   Slow and uncaring

d)   Rude

Q4. Which of the following terms best describes your dentist?

a)   Friendly

b)   Caring

c)   Professional

d)   Uncaring

e)   Insensitive

f)    Rude

g)   Don’t know

Q5. Which of the following terms best describes your dental surgery assistant?

a)   Friendly

b)   Caring

c)   Professional

d)   Uncaring

e)   Insensitive

f)    Rude

g)   Don’t know

Q6. How do you feel about the dental care costs?

a)   It is too expensive

b)   It is costly

c)   I can afford this

d)   I have a policy to take care of the cost

e)   I can’t afford this

f)    Don’t know

Q7. How do you rate the environment of the dental clinic?

a)   Excellent

b)   Good

c)   Average

d)   Poor

e)   No environment at all

Category: Satisfaction Questionnaire

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