Patient Reply Form | All Care Dental Clinic – Giving You a Beautiful Healthy Smile

Is the office location convenient for you? *

Yes

No

Is the office location convenient for your home or work? (If you anticipate frequent visits, location may be particularly important.) *

Yes

No

Is the office near public transportation? *

Yes

No

Does the office have convenient or affordable parking available? *

Yes

No

How available is the dentist? *

Is the dentist taking new patients? *

Yes

No

Does the dentist make evening or weekend appointments? *

Yes

No

Does the dentist have a solo or group practice? *

Solo

Group

If it's a group practice, Can you request to see your dentist? *

Yes

No

Do you like and trust the other dental professionals who may be involved in your care? *

Yes

No

Are special arrangements made for handling emergencies outside of office hours? Is the dentist available in emergency situations? *

Yes

No

Is the wait time to make an appointment acceptable? *

Yes

No

What is your impression after your initial consultation with the dentist? *

Good

Satisfactory

Excellent

Do you and the dentist have compatible communication styles? *

Yes

No

Does the dentist and dental staff follow guidelines for infection control? *

Yes

No

Are you comfortable with the dentist's general manner and treatment style? *

Yes

No

Does the dentist seem up-to-date on the latest treatment options? *

Yes

No

Does the dentist explain techniques that will help you prevent dental health problems? Are preventative home care instructions provided? *

Yes

No

Is the dentist open to your concerns, questions, and comments? *

Yes

No

What other considerations are important to you?

Is information provided about fees and payment plans before treatment is scheduled? *

Yes

No

Are the dentist's costs comparable to other dentists for the same procedures/visits? *

Yes

No

Concerning Specific Dental Conditions:- If you have a specific dental condition, symptoms or a family history for a condition, you may want to consider the following.

Are you convinced about taking the dentist's advice? *

Yes

No

Are you reassured by the dentist's comments and actions?

Yes

No

Any other suggestions to help All Care Dental Clinic for better services.. *