In an effort to serve you better, we would sincerely appreciate it if you would take a few moments to answer the following questions as honestly as possible. We know you don't have to fill this survey out or tell us who you are. However, as the owner of Aspire Family Dental®, I am trying to make sure we serve you in the best way possible. As you have noticed, I try to make sure you as a valued patient have the best in modern dental technology to help you receive the best treatment possible! We truly understand that we can't make everyone happy with the service we provide. However, we do ASPIRE to be the absolute best. That is why we have Aspire in our name! Your responses will assist us in both seeing where we are providing you with the best dental care and service and where we are falling short of that goal. Even if you are NOT happy with our service, we are asking for your help with suggestions to help make us be better at what our main goal is - To take care of you and every other patient with the best and most high tech dental care possible! If for any reason you want to remain anonymous, you may do so. However, sometimes it helps us a little more if we could find out some more details as to why you may like or do not like something about our service! As owner of Aspire Family Dental, I will make sure your information you provide ONLY stays with myself and my patientaAdvocate if this is your wish. ANY help you can give me to help you and other patients have a better experience at our office would be GREATLY appreciated! Sincerely, Todd R. Levine, DDS Owner of Aspire Family Dental®Which office did you visit?* Lockport Niagara Falls Buffalo Office (Hertel Ave.) Buffalo Office (Ontario St.) North Tonawanda Do you wish for us to keep your below information private? If you answer yes, the only people who will see your information will be the Owner (Todd R. Levine DDS) and the Patient Advocate.* Yes No When you first call the office was the receptionist(s)......? Please check all the apply.* Pleasant Happy Helpful Courteous Short Rude When you first made your appointment did the receptionist(s) schedule you in a timely manner?* Yes No When you first made your appointment was it an emergency visit or was it a regular visit?* Yes No Emergency visit being that you came in due to being in pain or a regular visit being a cleaning, consultation, fillings, etc.Did the receptionist(s) help to answer all the questions you may of had to your satisfaction?* Yes No When you arrivedat our office, how would you rate the assistance you received from the receptionist? Please check all the apply.* Prompt and helpful Helpful after I asked Slow and helpful Appearance of not caring Rude When you arrived how did the receptionist(s) appear? Please check all that apply.* Professional Happy Miserable/Moody Bad attitude How would you rate the cleanliness of our dental facility?* Excellent Good Fair Poor While waiting for your appointment, did the atmosphere feel...? Please check all that apply.* Typical Pleasant Homey Calm Uncomfortable Were you seen in a timely manner for your appointment?* Yes No How long did you have to wait?*less than 5 minutesBetween 5-15 minutesBetween 15-30 minutesBetween 30-45 minutesmore than 1 hourWhich term(s) do you think best describes the.....? Please check all that apply for each question. What was the name of your dentist?*Dr. LevineDr. HrabDr. DepountiDr. D'AngeloDr. MarianoDr. ZohurDr. HessDr. MicoliDr. KellerDr. MetchlerDr. BarrowDr. McLanahanI do not RememberHow would you rate your doctor?* Friendly Caring Professional Uncaring Insensitive Rude How would you rate your hygienist?* Friendly Caring Professional Uncaring Insensitive Rude What was the name of the assistant who was helping the doctor?*How would you rate your dental assistant?* Friendly Caring Professional Uncaring Insensitive Rude What was the name receptionist?*UntitledHow would you rate your receptionist?* Friendly Caring Professional Uncaring Insensitive Rude Did your dentist(s) take time to explain the procedure you were having done prior to starting?* Yes No Did your dentist(s) answer all your questions you may have had?* Yes No Did your hygienist(s) take the time to listen and understand your concerns?* Yes No Did you understand the home care instructions given to you by the doctor(s) or the hygienist(s)?* Yes No How would you rate your quality of your care at our office?*12345678910In general, how would you rate the dental services available in our office?* Great Very Good Good Acceptable Poor Would you recommend our office to your friends and family?* Yes No PLEASE Use the below space to help us better understand your above answers and provide ANY comments about your experience at our office.If you have ANY suggestions on how we can better serve you it would be GREATLY appreciated!You do not have to give us your name and contact info, but it would be nice to know who you are. We will keep your name confidential.Name First Last Email Phone
