Dental Hygiene Patient Satisfaction Survey -Process 4 - Spring 2015

The Waukesha County Technical College Dental Hygiene Consortium is dedicated to providing the highest quality health care to our clients. Your opinion of our services is necessary to achieve this quality.


  1. I received the best possible care provided by the dental hygiene student.
    Yes
    No
    Don't Know/Doesn't Apply


  1. Dental Hygiene Student Name:


  1. I was pleased with the supervising dentist.
    Yes
    No
    Don't Know/Doesn't Apply


  1. Supervising Dentist Name:


  1. I was pleased with the instructor.
    Yes
    No
    Don't Know/Doesn't Apply


  1. Instructor Name:


  1. My student was honest, courteous and respectful.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student listened carefully and encouraged questions.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student clearly explained the problems I have in my mouth.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student informed me of the dental services provided by the clinic.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student informed me where I might obtain dental treatment that could not be completed at the dental hygiene clinic.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student explained what was going to happen before each procedure.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student gave me the option to provide input regarding my treatment.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student clearly explained how to keep my mouth healthy.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My care was provided in a gentle, caring manner.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student used time efficiently.
    Yes
    No
    Don't Know/Doesn't Apply


  1. My student informed me of the time commitment required for treatment.
    Yes
    No
    Don't Know/Doesn't Apply


  1. The dental hygiene clinic was clean.
    Yes
    No
    Don't Know/Doesn't Apply


  1. I did not have difficulty contacting my student/clinic.
    Yes
    No
    Don't Know/Doesn't Apply


  1. I would return to the dental hygiene clinic for future care.
    Yes
    No
    Don't Know/Doesn't Apply


  1. I would recommend the clinic to a friend or relative.
    Yes
    No
    Don't Know/Doesn't Apply


  1. I found out about the clniic from:


  1. Additional comments...





School of Health General
WI