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Patient experience

Dental patient feedback template

Comfort, explanation of treatment and costs, hygienist and dentist care, and recommendation, for dental practices.

5 questions · about 2 minutes to complete · free on every plan

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Free account required. The template is copied into your workspace; edit anything before publishing.

When to use it
The day after the appointment.
Who it is for
Dental patients.

How to use this template

  1. Send it within 48 hours of the visit; response rates and recall both fall the longer you wait.
  2. Ask about communication ('explained things in a way I understood') before overall satisfaction.
  3. Do not ask for diagnoses or medications in a general feedback survey.

Questions in the dental patient feedback template

  1. 1. How comfortable were you made to feel during treatment?

    rating

  2. 2. Please rate your agreement:

    matrix · Treatment options were explained clearly, Costs were explained before treatment, The hygienist or dentist was gentle and attentive, Reception was friendly and efficient

  3. 3. How easy is it to get an appointment when you need one?

    single choice · Very easy, Easy, Difficult, Very difficult

  4. 4. How likely are you to recommend this practice?

    nps

  5. 5. Any comments?

    open text

What the results look like

IllustrativeSynthetic sample of 120 responses generated for this preview, not real survey data. Your results page shows the same charts for your own responses.

1.How comfortable were you made to feel during treatment?

120 answered
Average 3.7
Answer distribution
AnswerCountPercent
176%
21613%
32017%
44134%
53630%

2.Please rate your agreement:

120 answered
StatementStrongly disagreeDisagreeNeutralAgreeStrongly agreen
Treatment options were explained clearly7%13%20%22%38%120
Costs were explained before treatment6%12%21%26%36%120
The hygienist or dentist was gentle and attentive5%13%23%27%33%120
Reception was friendly and efficient8%12%22%23%36%120

3.How easy is it to get an appointment when you need one?

120 answered
Answer distribution
AnswerCountPercent
Very easy87%
Easy3731%
Difficult3731%
Very difficult3832%

4.How likely are you to recommend this practice?

120 answered
Average 6.8NPS -246 promoters · 26 passives · 48 detractors
Answer distribution
AnswerCountPercent
011%
165%
276%
365%
443%
51613%
687%
7119%
81513%
92118%
102521%

How to read these questions

  • rating: Report the mean and the top-two-box share (the two highest points). Top-two-box is easier to explain and less sensitive to a few extreme answers.
  • matrix: Compare rows on the same column (for example, % agree) to find the weakest statement, then look at who rates it lowest.
  • single choice: Read the share choosing each option, then cross-tab by a segment question to see who differs.
  • nps: NPS = % promoters (9–10) − % detractors (0–6). Check the margin of error before calling a change between two periods.

Frequently asked questions

Does a patient satisfaction survey need HIPAA safeguards?

If it collects no health information and is anonymous, generally no. If you link responses to patient records or ask about conditions, treat it as protected health information and get advice.

How long does the dental patient feedback survey take to complete?

About 2 minutes: 5 questions, most of them single-tap. Every question can be edited, removed or reordered in the builder before you publish.

Is this template free to use?

Yes. Every template is included on the Free plan. Sign up, click Use this template, and it is copied into your workspace where you can edit it, add your logo and share it by link, email or embed.

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