A dental satisfaction questionnaire reveals if a dental clinic is offering the dental care and other services properly and if the patients visiting the clinic are satisfied with the services offered. This helps government medical institutions and NGO’s in determining if the dental clinic is operating according to patient and dental care guidelines and if changes need to be implemented there or not.

Dental Satisfaction Questionnaire Sample

Name of the Individual: ____________________________________ Date: _____________

Sex: __________  Age: ___________  Marital Status: _______________

Address: ___________________________________________________

City: ________________ State: ______________  Zip: ______________

Telephone: ____________________  Email: ________________________

Dental Clinic: _____________________________________

Q1. How helpful is the dental staff at the clinic?

a)   Very helpful

b)   Helpful

c)   Have to ask for help

d)   Not very helpful

e)   Rude

Q2. Is the dental staff at the clinic forthcoming in imparting information?

a)   Yes

b)   No

Q3. Do you think the dental staff at the clinic is competent?

a)   Yes

b)   No

Q4. How long do you have to wait at the clinic for an appointment?

a)   I get an appointment immediately

b)   A few minutes

c)   15-30 minutes

d)   30-45 minutes

e)   Almost an hour

f)    More than an hour

Q5. Are you confident about the quality of treatment provided at the clinic?

a)   Yes

b)   No

Q6. Is the clinic using latest equipments of dentistry?

a)   Yes

b)   No

Q7. Which of the following bothers you the most at the clinic?

a)   Incompetent staff

b)   Doctors are not there

c)   No surgery room

d)   Equipments outdated

e)   Very expensive treatment

f)    Staff not well informed

Q8. Do they have a good complaints procedure in place?

a)   Yes

b)   No

Q9. Would you recommend this clinic to others?

a)   Yes

b)   No