* All fields are required.

Care and services

1. Was the delay reasonable between the scheduled time of your appointment and the actual time you were seen?

Specify the delay :
min

6  

5  

4  

3  

2  

1  

Comments :

2. Were you progressively informed of your exam or treatments as well as those to come?

6  

5  

4  

3  

2  

1  

Comments :

3. What is your degree of satisfaction for services rendered?

Dentist:

6  

5  

4  

3  

2  

1  

Hygienist:

6  

5  

4  

3  

2  

1  

Receptionist:

6  

5  

4  

3  

2  

1  

Care coordinator:

6  

5  

4  

3  

2  

1  

4. During your waiting period, did the following elements facilitate the wait?

Magazines

6  

5  

4  

3  

2  

1  

Informative videos

6  

5  

4  

3  

2  

1  

5. Was the staff courteous at your arrival?

6  

5  

4  

3  

2  

1  

Comments :

6. Did you experience any difficulties trying to obtain an appointment?

6  

5  

4  

3  

2  

1  

Comments :

Suggestions (so as to improve our service)

Security Code:

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IT IS ALWAYS A PLEASURE SERVING YOU