Belva Dental - Daly City, California

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Patient Satisfaction Survey

Dear Patient,

Our mission is to provide the finest of care while maintaining sound ethics and integrity. Please help us in our ongoing commitment to providing exceptional patient service by sharing your concerns and providing feedback about your experience with us. Your comments will be held in strict confidence and you do not have to sign your name unless you want to. We plan to use your suggestions to make our service to you and your family even better.

Thank you for taking the time to help us be a better dental office.

Dr. Nahid Saba

You could also fill out our review section on Yelp and Insiderpages:


InsiderPages	Yelp	Yahoo Local


Appointment
It was easy to make my appointment within a reasonable amount of time.
The appointment coordinator was polite, courteous, and helpful.
It was easy to schedule a convenient appointment.
Appointment options were given that suited my schedule.
I was seen on time for my appointments.
Comments:

Staff
Office personnel were courteous, helpful, and friendly.
The dentist was professional and courteous.
The dental hygienist was professional and courteous.
The dental assistant was professional and courteous.
The dentist was considerate and sensitive to my needs.
The dental hygienist was considerate and sensitive to my needs.
The dental assistant was considerate and sensitive to my needs.
Comments:

Treatment
My proposed dental treatment was clearly explained.
Any questions I had were answered properly.
I was given treatment alternatives.
My dental treatment was completed efficiently and in a timely manner.
I was pleased with the quality of my dental treatment.
The dental treatment was completed to my satisfaction.
The fees were explained prior to my treatment appointment.
The fees for service were fair.
I plan to remain a patient at this office.
Comments:

Facilities
The office location and parking were convenient.
The reception area was neat and clean.
The equipment was clean and presentable.
The temperature in the office was comfortable.
The lighting in the office was sufficient.
The music in the office was pleasant.
Comments:


Gender:		Female
		Male

Age group:		12-18
		18-35
		35-55
		55+

I have been visiting this office for:		First visit
		2 years
		3+ years

How would you like to be notified or contacted?		Phone
		Mail
		Email

Would you recommend Belva Dental to others?		Yes
		No
		Unsure

How did you hear about us?

	Family		Verizon Smartpages.com
	Friend		Print advertisement
	Dentist		Office sign
	Valley Yellow Pages		Yahoo! search
	SBC Yellow Pages		Google search
	West Valley Yellow Pages		Valpak

Has any of our staff impacted your visit positively or negatively?

Name:
Describe:
What did you like best about the office?

Describe:
What did you like least about the office?

Describe:

In what way(s) could we have made your experience better?

Describe:

If we have any question regarding your		Yes
comments, may we contact you?		No

Name:
Phone:
Email:

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