Survey

Thank you for choosing our office for your dental needs. Our team strives to ensure that our patients care is carried out in a warm, friendly environment. We want you to feel at home.

So that we may improve our patients’ services, we would like to ask that you take a few minutes to answer this survey.

Once again, thank you for choosing East Madison Dental. We look forward to seeing you soon!

1= Needs Improvement
3= Meets your expectations
5= Exceeds your expectations!!!

1. Your overall experience in our office. 1 2 3 4 5
   Comments:
2. How long were you in the reception area before taken to the exam room? Immediately 5-10 10-15 15-20 20+
   Comments:
3. Was the reception area comfortable? 1 2 3 4 5
   Comments:
4. How long where you in the exam room before seeing doctor/hygienist? Immediately 5-10 10-15 15-20 20+
   Comments:
5. Was the exam room comfortable? 1 2 3 4 5
   Comments:
6. Handling of your phone calls. 1 2 3 4 5
   Comments:
7. Courteousness and concern of the Scheduling Coordinators. 1 2 3 4 5
   Comments:
8. Courteousness and concern of the Financial Coordinator. 1 2 3 4 5
   Comments:
9. Were the insurance and/or financial options explained to you in an understandable way? 1 2 3 4 5
   Comments:
10. Courteousness and concern of the doctor. 1 2 3 4 5
    Comments:
11. Courteousness and concern of chairside assistants. 1 2 3 4 5
    Comments:
12. Professionalism and gentleness of the doctor. 1 2 3 4 5
    Comments:
13. Professionalism and gentleness of chairside assistants. 1 2 3 4 5
    Comments:
14. Our response and attentiveness to your concerns. 1 2 3 4 5
    Comments:
15. The quality of services we provide. 1 2 3 4 5
    Comments:
16. Was your treatment plan explained to you in an understandable way? 1 2 3 4 5
    Comments:
17. Is there anything that we can do to make you feel more comfortable? Yes No
    Comments:
18. Would you recommend friends and family to East Madison Dental? 1 2 3 4 5
    Comments:
19. Please provide any comments on how we can make your visit better, new services you would like to see.
    
20. VOTE FOR EMPLOYEE OF THE MONTH!
    Is there any employee at East Madison Dental that made your experience even more enjoyable? No Choice/Other Adele Denise Gráinne Hillary Karen Maria Mary
    Other:
21. Your Name (optional)
22. Would you like someone to contact you to discuss your suggestions? Yes No