Cabrillo College

Dental Hygiene Home

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Application 10/05

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American
Dental Hygiene Association

California
Dental Hygiene Association (CDHA)

Monterey
Bay Dental Hygiene Association (MBDHA)

Committee
on Dental Auxiallaries (COMDA)

Cabrillo College Dental Hygiene

Patient Satisfaction Survey

Cabrillo College Dental Hygiene Clinic is dedicated to providing health care of the highest quality to our patients. Your opinions of our services are appreciated. Please take a few moments to complete this survey and give it to our Receptionist. Thank you for the continued support of our program and helping us make Cabrillo College Dental Hygiene Clinic a better place to receive dental hygiene care.

Cordially,
Bridgete Clark, R.D.H., D.D.S.
Program Chair, Dental Hygiene

Date

Please check the box that best describes your opinion.

		Yes	No
1.	I was pleased with the care provided by my student hygienist.
2.	His/her name was:
3.	I was pleased with the dental hygiene instructor.
4.	His/her name was:
5.	I was pleased with the supervising dentist.
6.	His/her name was
7.	My student hygienist was friendly and respectful.
8.	My student hygienist listened carefully and encouraged me to ask questions.
9.	My student hygienist clearly explained the problems I have in my mouth and how to keep my mouth healthy.
10.	My student hygienist explained what was going to happen before each procedure.
11.	My student hygienist knew when I was in pain and did something about it.
12.	My student hygienist used procedures that made me feel safe from catching a disease or infection.
13.	Overall, I was pleased with the care I received at Cabrillo College Dental Hygiene Clinic.
14.	The Cabrillo College Dental Hygiene Clinic was easy to find.
15.	I was given enough information about what to expect during my appointment? Fees?
16.	Did you have difficulty scheduling your dental appointments?
17	I had a comfortable place to sit while you were waiting for your student hygienist?
18.	The facility was clean.
19.	The cost for dental hygiene services at Cabrillo College is reasonable.
20.	I would you recommend dental hygiene treatment at Cabrillo College to a friend or relative.
21.	I waited in reception area at the Dental Hygiene Clinic for
22.	I traveled for my treatment today.
23.	Additional Comments:

Thank you for your time!
Please click submit once.

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Cabrillo College, 6500 Soquel Drive, Aptos, CA 95003, phone: 831-479-6100