®

CUSTOMER SATISFACTION QUESTIONNAIRE

Our People... EXPECTATIONS
  Exceeded Met Below Does Not Apply
Were courteous on the phone
Gave you a friendly greeting upon arrival
Provided thorough explanations on your progress during and after treatment
Looked professional in appearance
Overall, how did our staff perform?
 
Quality Care & Service... EXPECTATIONS
How well did our staff provide you with quality service in these areas? Exceeded Met Below Does Not Apply
Reception area and front desk
Explanation of financial arrangement
Care by the Doctor
Care by the Dental Team
Overall, How would you rate our care and service?
Our Office... EXPECTATIONS
  Exceeded Met Below Does Not Apply
Schedule an appointment for you within a reasonable amount of time
Delivered prompt service by the Doctor
Offered a comfortable, clean reception area
Overall, How would you rate the office efficiency?
 
We would also like to know more about you...
What is the age group of the patient?
Under 18 18 - 35
36 - 55 Over 55 years of age
How long have you been coming to our office?
1st visit less than 3 months
3 - 12 months 1 - 5 Years
5+ Years  
Would you recommend our office to others?
Definitely would Definitely would not
Uncertain  
Thank You!
We welcome your comments regarding your general impression of our people and office. Please comment below.
Did anyone provide you with outstanding service?  Yes       No
Name(s)
I am especially pleased with
Verification:
You need to improve
If you have additional comments and would like to be contacted by a member of our staff, please write your name and telephone number in the space provided
Name Phone
about us | dental services | client resources | photo gallery | contact us | home
© 2002-2012 Fawcett Center for Dentistry, P.A.
Our Houston dental office is located at 13956 Cutten Rd. Houston, TX 77069 281-440-6648
® The swirl background design is a registered trademark of Wayde Fawcett, DDS.