Dental care monitoring questionnaire template

1. Do you presently have a dentist that you visit on a regular basis?

2. How did you find your dentist?

Referral by friend / family
Referral by another dentist
Referral by school
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Can't remember

3. The most common reason for not going to the dentist is:

I do go for regular check-ups
The cost of care
I don't need to go very often
I forget to go
I don't like dentists
There is nothing wrong with my teeth
I am scared!

4. Since when have you made regular visits to the current dentist?

< 1 year
1-2 years
2-3 years
3-4 years
4+ years

5. Do members of your household go to:

One dentist
More than one dentist

6. How often do you go to the dentist for checkups?

Every 6 months
At least once a year
At least every 2 years
At least once every 3-4 years
It depends, I go when I have trouble with my teeth

7. Would you like your dentist to notify you when it is time for a check-up?

Yes
No
Not sure

8. How would you prefer to receive this notice?

Phone call
SMS
E-mail

9. What do you like best about your personal dentist?

500

10. What would you suggest that might make a visit to your dentist more pleasurable?

500

Dental Care Survey

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Become a top dental institution and patients will find you. The questionnaire template for dental care will give you objective information on the level of your care.

Use template

The survey sample is ideal for

dentists,
workers in the field of dentistry.

Background, staff, services, facilities or availability. To this extent, the level of medical facilities is usually assessed. Get an idea of what current patients think of your office or clinic. At the same time, you can read from the answers how consistently they take care of their teeth and, based on the examination, you will design a plan of preventive examinations. Have them fill out the questionnaire for dental care monitoring and meet their expectations, which will provide you with positive recommendations and bring in new potential patients.

See how patient surveys drive improvement in service quality and patient experience.

The questionnaire template can be fully edited. Survio will process your answers into well-arranged tables and graphs.

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Dental care monitoring questionnaire template

1. Do you presently have a dentist that you visit on a regular basis?

2. How did you find your dentist?

3. The most common reason for not going to the dentist is:

4. Since when have you made regular visits to the current dentist?

5. Do members of your household go to:

6. How often do you go to the dentist for checkups?

7. Would you like your dentist to notify you when it is time for a check-up?

8. How would you prefer to receive this notice?

9. What do you like best about your personal dentist?

10. What would you suggest that might make a visit to your dentist more pleasurable?

Dental Care Survey

Template categories

Survio is a survey software for everyone.

Create a questionnaire in less than one minute

Collect survey responses on multiple channels

Analyze survey results with a single click

What people say about us

It’s not just a template. You’ll get the entire survey platform to collect desired data and understand them.

Dental care monitoring questionnaire template

1. Do you presently have a dentist that you visit on a regular basis?

2. How did you find your dentist?

3. The most common reason for not going to the dentist is:

4. Since when have you made regular visits to the current dentist?

5. Do members of your household go to:

6. How often do you go to the dentist for checkups?

7. Would you like your dentist to notify you when it is time for a check-up?

8. How would you prefer to receive this notice?

9. What do you like best about your personal dentist?

10. What would you suggest that might make a visit to your dentist more pleasurable?

Dental Care Survey

Template categories

Survio is a survey software for everyone.

Create a questionnaire in less than one minute

Collect survey responses on multiple channels

Analyze survey results with a single click

What people say about us

It’s not just a template. You’ll get the entire survey platform to collect desired data and understand them.

Enter Survio

Create engaging surveys, get genuine data and make the right decisions.

Start surveying now!