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

Today's 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 condition of 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 dental hygienist used procedures that made me feel safe from infection or exposure to disease.
12.	Was scheduling your dental appointment a pleasant experience?
13.	I was given adequate information regarding my appointments and the cost.
14.	The Cabrillo College Dental Hygiene Clinic was easy to find.
15.	Did you have a comfortable place to sit while you were waiting for your student hygienist?
16.	The facility was clean.
17.	The cost for dental hygiene services at Cabrillo College is reasonable.
18.	Overall, I was please with the care I received at Cabrillo College Dental Hygiene Clinic.
19.	Would you recommend dental hygiene treatment at Cabrillo College to a friend or relative.
Please select the best answer from the menu.
20.	I waited in reception area at the Dental Hygiene Clinic for
21.
22.	I traveled for my treatment today.
23.
24.	Additional Comments:

Thank you for your time!

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Main Campus, 6500 Soquel Drive Aptos CA 95003, call: 831.479.6100

Patient Satisfaction Survey

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