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Dental Care Survey
Family dental choice profile, evaluation and importance of factors in choosing a dentist
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It's completely Free!
Here is the Dental Care Survey template.
Introduction text here.
Do you presently have a dentist that you visit on a regular basis?
How did you find your dentist?
Referral by friend/neighbor
Referral by acquaintance
Referral by another dentist
Referral by doctor
Do members of your household go to (check all that apply):
More than one dentist
An oral surgeon
Other dental specialist
The most common reason for not going to the dentist is:
I do go for regular check-ups
The cost of care
I don't need to go very often
I forget to go
I don't like dentists
There is nothing wrong with my teeth
Since when have you made regular visits to the current dentist?
< 6 months
6 months - 1 year
How often do you go to the dentist for checkups?
Every 6 months
At least once a year
At least every 2 years
At least once every 3-4 years
It depends, I go when I have trouble with my teeth
Would you like your dentist to notify you when it is time for a 6-month check-up?
If you would like your dentist to notify you when it is time for a check-up, how would you prefer to receive this notice?
If two weeks go by and you had not yet made an appointment, would you like them to call back again?
I would prefer the following payment plan for my dental care:
Payment required at the time of care (cash/check)
Payment by charge cards at the time of care (VISA, Mastercard, etc.)
Monthly payment plan at 1.5% interest per month
Payment due within 30 days
Dental charges may vary subject to the amount of time that the dentist takes to complete a procedure, as well as the kind of work performed. If the cost were the same, what kind of dentist would you prefer?
Takes a little longer to get the job done, but talks to you during the procedure (cost $45, 45 minutes time)
Completes the work more rapidly and talks less (cost $45, 30 minutes time)
Completes the work very rapidly (cost $45, 20 minutes time)
Would you expect the dentist who takes longer to do a better job?
What do you like best about your personal dentist?
What would you suggest that might make a visit to your dentist more pleasurable?
It's completely Free!