Patient Survey

If you had a recent visit with us for something other than a cleaning, you can still provide us with your feedback, however, your entry will not be eligible for the monthly draw.

User Information

Name : Email Address :

When was your last visit at Schau Dental?

dd/mm/yy:

Where you greated warmly when you entered the office?

Yes
No

Where you seen on time?

Yes
No

If you were not seen on time, where you informed there was going to be a delay?

Yes
No

Was your cleaning performed to your satisfaction?

Yes
No

If not, what could have been done differently?

Was the hygienist friendly and welcoming?

Yes
No

How could our Hygienist have made your stay more enjoyable?

Was Dr. Schau courteous and welcoming?

Yes
No

How could Dr. Schau have made your stay more enjoyable?

Where your treatment needs explained to you in a way that you could understand?

Yes
No

What could we have done to help you better understand your dental needs?

Was your invoice handled to your expectations?

Yes
No

If no, how can we improve how we handle the financial end of your visits?

Are there any upgrades to our office you would like to see?

Are you aware of the following? Check those that apply.

We see children.
We provide orthodontic care including Invisalign.
We use digital radiography.
We appreciate you have chosen the Schau Dental team as your oral care providers.

Will you refer your friends and family to Schau Dental?

Why?:
Why not?: