Chestnut Hills Dental | Patient Satisfaction Survey

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Chestnut Hills Dental

Patient Satisfaction Survey

At Chestnut Hills Dental, we are dedicated to delivering the highest standard of dental care and service to our patients. In attempting to accomplish this goal, we ask for your help. Please take a few minutes to answer each question below by selecting the appropriate response.

If you would like to give us your name in the field provided you may, but it is not required. Your survey will be sent directly to our Quality Improvement Administrator, not to the office. We use this information to make our patients' experience at Chestnut Hills Dental even better.

We appreciate your time and feedback!

We recommend that you use the latest version of Microsoft Internet Explorer, Netscape Navigator or Mozilla Firefox with this form. If you do not have a current version please download and install it (free downloads) to ensure the form data gets sent properly.

First and Last Name (Optional):

Date of Last Visit (Mo\Year)
Office Location of your last visit:

Which Dentist did you see?
Which Hygienist did you see? (if applicable)

How were you treated by our Front Desk team?
I would like to explain why I chose the answer that I did (optional):


Did you have any interaction with the Practice Manager?
If Yes, how was that experience? Were your concerns heard and addressed?


Please Rate The Following

1. The overall appearance of the office
2. The availability of your appointment
3. The ease of getting through to us by phone
4. The time between making your appointment and the day of your visit
5. How many days did you have to wait to see us due to availability?
6. The convenience of office hours
7. The time of day of your appointment
8. The professionalism of your care provider
9. The explanation of treatment options and alternatives
10. Your concerns were heard and addressed
11. Your dentist spent enough time with you
12. The overall quality of care you received

Do you have anything else you would like us to know?

Thank you for taking the time to fill out our Patient Satisfaction Survey. Your opinion is important to us! Your survey will be sent to our Quality Assurance Coordinator, not to the offices. We use this information to make our patients' experience at Chestnut Hills Dental even better. Please click the "Submit" button (only once) and your survey will be sent to Chestnut Hills Dental.