Dr. Steven England, DDS Southwest Family Dentistry
Request an Appointment

Or Call (614) 276-1661

Columbus, OH

Patient Satisfaction Survey


In order to find out how we are meeting your needs, we are asking our patients a few questions about the care they have received at our Columbus, OH office. Please be honest in your answers. Your comments will be held in strict confidence and you do not have to sign your name unless you want to. We plan to use your suggestions to make our service to you and your family even better. Thank you for your comments.

Please complete items 1-3 to describe yourself:

* = Required

* 1. Age:





* 2. Gender:



* 3. Treatment Completion:

* The treatment was for:



* The treatment was:



The list below includes statements about the care you received at our office.

Please place a check mark under the column to indicate whether you agree, disagree or are not sure about each one. Please explain the ones you disagree with next to "Comments."

Appointments

Agree

Unsure

Disagree

  • It was easy to make my first appointment.
Agree
Unsure
Disagree
  • The appointment secretary (coordinator) was polite and helpful.
Agree
Unsure
Disagree
  • I received a reminder of each of my appointments.
Agree
Unsure
Disagree
  • It was easy to schedule a convenient appointment.
Agree
Unsure
Disagree
  • Appointment options were given that suited my schedule.
Agree
Unsure
Disagree
Comments:

Facilities

Agree

Unsure

Disagree

  • The office location and parking were convenient.
Agree
Unsure
Disagree
  • The reception area was neat and clean.
Agree
Unsure
Disagree
  • The equipment was clean and presentable.
Agree
Unsure
Disagree
  • The temperature in the office was comfortable.
Agree
Unsure
Disagree
  • The lighting in the office was sufficient.
Agree
Unsure
Disagree
  • The music in the office was pleasant.
Agree
Unsure
Disagree
Comments:

Staff

Agree

Unsure

Disagree

  • The dentist was professional and courteous.
Agree
Unsure
Disagree
  • The dental hygienist was professional and courteous.
Agree
Unsure
Disagree
  • The dental assistant was professional and courteous.
Agree
Unsure
Disagree
  • The dentist was considerate and sensitive to my needs.
Agree
Unsure
Disagree
  • The dental hygienist was considerate and sensitive to my needs.
Agree
Unsure
Disagree
  • The dental assistant was considerate and sensitive to my needs.
Agree
Unsure
Disagree
  • Other office personnel were courteous and helpful.
Agree
Unsure
Disagree
Comments:

Treatment

Agree

Unsure

Disagree

  • My proposed dental treatment was clearly explained.
Agree
Unsure
Disagree
  • Any questions I had were answered.
Agree
Unsure
Disagree
  • I was given treatment alternatives.
Agree
Unsure
Disagree
  • My dental treatment was completed efficiently and in a timely manner.
Agree
Unsure
Disagree
  • I was pleased with the quality of my dental treatment.
Agree
Unsure
Disagree
  • The dental treatment was completed to my satisfaction.
Agree
Unsure
Disagree
  • The fees were explained prior to my treatment appointment.
Agree
Unsure
Disagree
  • The fees for service were fair.
Agree
Unsure
Disagree
  • I plan to remain a patient at this office.
Agree
Unsure
Disagree
Comments:

Additional Comments

What I liked best about the office was:
What I liked least about the office was:
In what way(s) could we have made your experience better?
Name (optional):
* May we have permission to publish your comments on our website?



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