Patient satisfaction survey

Personal Details:

We would like you to think about your recent experience of Park Lane Orthodontics. How likely are you to recommend our orthodontic practice to friends or family if they needed similar care or treatment?

Extremely LikelyLikelyNeither likely or unlikelyUnlikelyExtremely UnlikelyI don’t know

Staffing:

On a scale of 1 to 10, with 1 being very dissatisfied and 10 being totally satisfied,
how happy were you with the service you received from:

12345678910

12345678910

12345678910

12345678910

YesNo

Overall:

Please rate the following aspects of your treatment:

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

IdealAcceptableNot Acceptable

How satisfied are you with the following?

Totally SatisfiedSatisfiedNeitherDissatisfiedTotally Dissatisfied

Totally SatisfiedSatisfiedNeitherDissatisfiedTotally Dissatisfied

Based on your total time in treatment, how likely would you be to recommend Park Lane Orthodontics to your family, friends and colleagues?

Extremely LikelyVery LikelyNot Very LikelyNot Likely At All

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