Online Survey

How satisfied were you? Please fill in the following to give us feedback

Please note that it is optional to insert your Name and Email Address

Your Name
Email Address

Rate your satisfaction on the following scale, where 1 represents "Not Satisfied" and 5 represents "Very Satisfied".

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Wait Time
Facility Cleanliness
Doctor Friendliness
Receptionist Friendliness
Thoroughness of Care

Rate your satisfaction on the following scale, where 1 represents "Not Satisfied" and 5 represents "Very Satisfied".

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2
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4
5
How satisfied were you with your overall experience?

Please fill in the following to give us feedback

What did you like best about your visit to our center?
What could we improve to make your next visit better?
Which dentist treats/treated you?      Diego       Alix
Do you     pay or     submit to medical aid?
Do you     attend regularly or     as problems arise

Rate your satisfaction on the following scale, where 1 represents "Not Satisfied" and 5 represents "Very Satisfied".

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2
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5
You were made to feel welcome at the practice?
Waiting time before seeing the dentist
You were made to feel relaxed during treatment
Receptionist friendliness
Receptionist efficiency
Dentist attentiveness and empathy
Dentist thoroughness and professionalism
Painless treatment
Cost of treatment
Practice cleanliness
Overall satisfaction with your treatment at West Coast Dental
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