About this template
Understanding how patients perceive their dental visits is essential for building a thriving practice and delivering exceptional care. This Dental Patient Experience Survey template allows dental clinics, orthodontists, and oral surgeons to seamlessly gather candid feedback regarding appointments, chairside manner, facility comfort, and overall satisfaction.
By collecting structured insights after visits, practice managers and lead dentists can identify operational bottlenecks, highlight staff members who excel in patient comfort, and make data-driven improvements to clinical workflows. The form covers key touchpoints from the initial check-in and treating dentist interactions to comfort amenities and net promoter scores.
Deploying this digital survey helps dental teams show patients that their opinions matter, fostering stronger patient loyalty and higher retention rates without the friction of paper clipboards.
Key features
- Evaluate dentist attitude and chairside demeanor objectively.
- Measure patient loyalty with built-in recommendation metrics.
- Identify clinic comfort amenities that patients appreciate most.
- Pinpoint exact areas for clinical and administrative improvement.
- Transition entirely to contactless digital feedback collection.
Use cases
Post-appointment satisfaction follow-ups sent via email or SMS.
Annual patient experience audits for multi-doctor dental practices.
New clinic service evaluations to test patient reception of new treat…
New clinic service evaluations to test patient reception of new treatments.
What this form collects
- Patient Visit Status (Multiple choice)Are you a new patient or a returning visitor to our clinic?
- How did you hear about our dental practice? (Dropdown)Select the primary source that led you to our office.
- How often do you visit the dentist? (Multiple choice)Tell us about your general dental check-up routine.
- Treating Dentist Full Name (Short answer)Please enter the name of the dentist or hygienist who treated you today.
- How satisfied were you with your treating dentist's attitude and care? (Linear scale)Rate how well your dentist listened to your concerns and explained procedures.
- Which comfort amenities did our staff provide during your visit? (Checkboxes)Select all comfort features that enhanced your experience.
- How likely are you to recommend our practice to friends or family? (Linear scale)0 = Not at all likely, 10 = Extremely likely.
- What could we do to improve your future visits? (Paragraph)Share any suggestions regarding our waiting time, staff, facility, or treatment process.
FAQ
How can I share this survey with my dental patients?
You can easily share the generated Google Form link via automated SMS follow-up messages, email newsletters, or by embedding a QR code directly at the front desk check-out counter.
Can I customize the questions to fit our specific dental practice?
Yes! Because the template opens directly inside Google Forms, you have full freedom to add, remove, or modify questions to match your clinic's branding and specific service offerings.
Is patient feedback collected anonymously?
You can choose whether to collect patient names and contact details or keep submissions entirely anonymous to encourage honest, uninhibited feedback.
How do I review the survey responses?
All submissions instantly populate a linked Google Sheets spreadsheet, allowing your team to analyze ratings, track trends over time, and export data effortlessly.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.