Dr. Kvitko and Associates, Dentist in Columbus, Ohio

Dr. Kvitko & Associates, Dentist in Columbus, Ohio

Patient Satisfaction Survey

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Now that your work has been completed, we would like to ask you a few questions regarding your overall experience in our office. Your response will be of great help to our staff in maintaining and improving the quality of service we provide our patients in the future. Would you please take a few minutes to complete the questionnaire below?

How did you choose our office?

Family/friend referral
Phone book
Internet
TV
Radio
Name of Station
Other

Did you contact us by phone?

yes
no

Telephone courtesy

Was your call handled promptly?

Did you contact us by email or through our website?

yes
no

How was the response time?

Was our website user-friendly?

Did you complete your health forms online?

yes
no

How did this compare to filling out forms in the office?

Was the form user-friendly?

yes
no

Was your wait in the reception area reasonably short?

yes
no

Were you greeted promptly?

Was the office clean and comfortable?

Was your treatment in the office pleasant?

yes
no

Helpful and courteous clinical staff?

Did they help you feel comfortable?

Was total charge for treatment close to the estimate given?

yes
no

Explanation of needed treatment

Answering insurance or financing questions

What did you like most about our office?

What did you like least about our office?

Would you recommend your friends and family to our office?

yes
no

How would you rate your overall service?

Since we are continually trying to improve our service to you, our valued patient, please let us know anything we can do to make your visit with us more pleasant.

Please note, unless you state otherwise, by submitting this form you are giving Dr. Kvitko & Associates permission to use your comments in our promotional materials. View Privacy Statement.

Thank you!

Dr. Kvitko & Associates