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Dental patient satisfaction survey template

Dental patient satisfaction survey template

Gain insights into your patients’ experiences with our detailed satisfaction survey template. Use feedback to improve services, boost patient satisfaction, and grow your practice. Download your free PDF from Lumiform today!

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  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
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or Download template as PDF
Dental patient satisfaction survey template

Gain insights into your patients’ experiences with our detailed satisfaction survey template. Use feedback to improve services, boost patient satisfaction, and grow your practice. Download your free PDF from Lumiform today!

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

ThOS dental patient satisfaction survey template helps you gather valuable feedback directly from your patients about their experience at your practice. This digital form captures insights on key aspects like appointment scheduling ease, wait times, staff friendliness, treatment quality, and facility cleanliness.

You can quickly identify improvement areas when patients consistently report long wait times or communication issues with billing staff. With automated reporting features, you’ll spot trends and make data-driven decisions to enhance patient loyalty and grow your practice. We designed this template to replace unreliable paper surveys while increasing response rates through convenient digital access.

Related categories

  • Health and safety management templates
  • Health care templates
  • Quality assurance templates
  • Templates for business processes
Preview of the template
Page 1
General Satisfaction
Overall, how satisfied are you with the dental services you received?
How likely are you to recommend this dental practice to a friend or family member?
Appointment and Wait Times
How satisfied were you with the ease of scheduling your appointment?
How satisfied were you with the amount of time you had to wait for your appointment?
Staff and Environment
How satisfied were you with the friendliness and professionalism of the dental staff?
How satisfied were you with the cleanliness and comfort of the dental office?
Dental Procedures
How satisfied were you with the quality of the dental work performed?
How satisfied were you with the explanation of the dental procedures?
How satisfied were you with the level of pain or discomfort during the dental procedures?
Additional Feedback
Please provide any additional feedback or comments about your dental experience.

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Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

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Frequently asked questions

What questions should I include in my dental patient satisfaction survey?

Your survey should include questions about appointment scheduling, wait times, staff friendliness, treatment explanation clarity, pain management, facility cleanliness, and billing processes. Also add an open-ended question allowing patients to share additional feedback or suggestions for improvement that might not be covered by standard questions.

How can I increase the response rate for my dental patient satisfaction survey?

Offer multiple completion options (in-office tablet, email link, text message) and keep the survey brief—under 5 minutes to complete. Consider offering small incentives like entry into a monthly drawing or a discount on dental products. Most importantly, tell patients how their feedback directly improves your practice and share examples of changes made based on previous surveys.

When is the best time to send a dental patient satisfaction survey?

Send the survey within 24-48 hours after the patient’s appointment when the experience is still fresh in their mind. For complex treatments requiring multiple visits, consider sending a survey after the treatment series is complete rather than after each individual appointment to capture the overall experience without causing survey fatigue.

How do I analyze the results from my dental patient satisfaction survey?

Group feedback into categories (staff interaction, clinical care, office environment, administrative processes) and look for patterns rather than focusing on isolated comments. Track satisfaction scores over time to identify trends and measure the impact of changes you implement. Pay special attention to open-ended responses as they often contain the most valuable insights for improvement.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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