Patient Survey

Excellent Care ~ Exceptional Service
Did we meet the grade?
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Clinic Location:

Upon arrival I was greeted courteously.


1 Needs Improvement	2	3 Good	4	5 Exceptional

I was seated by my appointment time or advised of any delays.


On Time	15 minute wait	30 minute wait	45 minute wait	1 hour wait (or more)

I felt the doctor and team listened and understood my dental concerns.


1 Needs Improvement	2	3 Good	4	5 Exceptional

I felt that everyone was concerned about my total wellbeing as a person, not just my dental needs.


1 Needs Improvement	2	3 Good	4	5 Exceptional

I feel I understand the treatment prescribed and all of my questions were answered to my satisfaction.


1 Needs Improvement	2	3 Good	4	5 Exceptional

Payment options were discussed and financial arrangements made for all treatments.


1 Needs Improvement	2	3 Good	4	5 Exceptional

Please rate the overall courtesy and friendliness of the office staff and the dental team.


1 Needs Improvement	2	3 Good	4	5 Exceptional

Please rate your overall comfort level in the office.


1 Needs Improvement	2	3 Good	4	5 Exceptional

The reception area, restroom and treatment rooms are clean and comfortable.


1 Needs Improvement	2	3 Good	4	5 Exceptional

I would recommending this office to family and friends.


1 Needs Improvement	2	3 Good	4	5 Exceptional

Do you enjoy our Patient Newsletter


1 Needs Improvement	2	3 Good	4	5 Exceptional

Do you feel our fees are reasonable


1 Needs Improvement	2	3 Good	4	5 Exceptional

Did you clearly understand the discharge/post-op instructions?


1 Needs Improvement	2	3 Good	4	5 Exceptional

Did you have treatment done with


Freezing	Local Anaesthetic	IV Sedation	General Anaesthetic

If you selected IVS or GA:
Did the anesthesiologist make you feel comfortable and safe?


0 Not Applicable	1 Needs Improvement	2	3 Good	4	5 Exceptional

Did the recovery room experience meet your needs? (if applicable) If not please let us know why

Are there any team members you would like to recognize for outstanding care or service?

Additional Comments

Thank you in advance for referring your family and friends!

Patient Infomation (optional)

Name
Email
Phone
Date of Visit

Able Dental Group

515 - 5th Street S
Lethbridge, AB T1J 2B9
Toll Free: 1-800-552-8053
Phone: 403-327-7227
Fax: 403-327-8816
info@abledentalgroup.com

Dentist Lethbridge

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