Patient Survey Questionnaire

We need to know how we can better serve you. If you are a patient of our office we would appreciate very much if you could provide us with your assessment of your experience by answering our brief Patient Survey Questionnaire.

You can fill out the following online form and submit it to us now (anonymously if you choose).

You can also choose to download our Patient Survey Questionnaire as an easy-to-print PDF, fill it out and drop it off, mail it or fax (207) 236-4704 it to us.

Your valuable information will help to ensure that your patient experience surpasses your expectations.

Please answer the private questions below so that we can continue to improve our service.

When you telephoned to make an appointment, the staff members was courteous and helpful in finding a suitable time?

Upon arrival, were you greeted in a friendly manner and made to feel comfortable?

Were you seated by your appointment time or advised of any delays?

Did the dentist/hygienist take the time to listen to and understand your concerns?

Did the dentist/hygienist take the time to adequately explain the treatment plan and answer your questions?

Did you feel that you understood the prescribed treatment and all of your questions were answered to your satisfaction?

Upon receiving your bill for the services redeemed was the amount clearly described?

Upon receiving your bill for the services redeemed were payment options discussed?

If you had a concern during your last visit, do you think it was properly handled by the staff?

During your last visit, did you feel that the staff was concerned about your overall well being as a person and not just your dental condition?

Are you comfortable with the level of technology used in the office?

Using the rating of 1 to 5, with 5 being the highest score how do you rate our office?

Are you aware that we are accepting new patients?

Is there anything you would like to change about your smile?

Would you be interested in a free cosmetic consultation with the doctor?

Would you like to refer a friend or family member to our office?

1 + 12 =

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