Survey

Satisfaction Survey

• First Name *

• Last Name *

• Email *

• Which dental office do you go to? *

  … Dunlap Office East Peoria Office

• Which dentist do you see? *

  … Dr. Erin Shanahan Dr. George Duncan Dr. Timothy Ruffner Dr. Devin Croft Dr. Bill Costaras Dr. John Pappas

• How do you feel about the waiting time? *

  … Much too long Too long About Right

• How long do you usually wait when you have an appointment? *

  … Less than 15 min. 15-30 min. 30-60min More than 1 hr.

• Do you usually receive the treatment/service you need during your visit? *

  … Yes No

• How would you rate the cleanliness of the office? *

  … Excellent Good Fair Poor

• When you arrived, how would you rate the assistance you received from the reception? *

  … Prompt & Helpful Helpful after I asked Slow & unhelpful Rude

• Do you feel the costs of your visits are? *

  … Too expensive A little to costly Reasonable

• How would you rate the quality of the dental work you receive? *

  … Excellent Good Fair Poor

• Which term best describes the Dentist? *

  … Friendly Caring Professional Uncaring Insensitive Rude Did not see the dentist

• Which term best describes your Hygienist? *

  … Friendly Caring Professional Uncaring Insensitive Rude Did not see hygienist

• Which term best describes the front desk assistants? *

  … Friendly Caring Professional Uncaring Insensitive Rude Did not see front desk assitants

• Would you recommend our office to your friends and family? *

  … Yes No

• In your own words, let us know any issues or concerns you may have about our services or office practices and procedures.