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Wisconsin Airway Institute
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Patient Satisfaction Survey

We hope that you have had a comfortable and pleasant experience in our office. It is our greatest pleasure to have you as a patient! As you know, our practice is committed to 100% patient satisfaction. Because we are proud of the beautiful smiles we have created in this community, we want you to be excited about all of the services we provide. We value your opinion and would greatly appreciate it if you would take a moment to share your impressions of our practice. Thank you for your time!
	A = Excellent B = Average C = Could be improved
1.	Friendliness of staff.	A	B	C
2.	The value of the services we provide.	A	B	C
3.	The quality of our service.	A	B	C
4.	Treatment area was clean and attractive.	A	B	C
5.	Reception room was comfortable.	A	B	C
6.	Doctor was gentle.	A	B	C
7.	All your questions were answered to your satisfaction.	A	B	C
8.	Hygienists were gentle.	A	B	C
9.	Chair-side assistants were gentle.	A	B	C
10.	Dental hygienists were knowledgeable and courteous.	A	B	C
11.	Doctor was helpful and knowledgeable.	A	B	C
12.	Courteousness and concern of chair-side assistants.	A	B	C
13.	Front desk personnel was professional and courteous.	A	B	C
14.	We were on time for you.	A	B	C
15.	Treatment consultations were comprehensive	A	B	C
16.	The front team was courteous and helpful.	A	B	C
17.	Scheduling of appointments worked for you.	A	B	C
18.	Would you recommend our office to your friends?	A	B	C

	How did you hear about us?
	Do you have any additional comments that would help us to improve?

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Verona, WI 53593

(608) 845 - 6127

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