Dental Office First Visit Feedback

Dental Office First Visit Feedback — Form Fields

This feedback template includes 9 fields. Collect impressions from first-time dental patients on appointment ease, staff welcome, comfort, and overall experience. Free to customize and use on ZenBuild.

• Type of visit (dropdown selection, required) — options: Routine cleaning, X-rays, Filling, Consultation, Emergency visit, Other
• Ease of scheduling your appointment (rating, required)
• Reception staff friendliness (rating, required)
• Waiting room comfort and cleanliness (rating, required)
• Dentist or hygienist professionalism (rating, required)
• Explanation of treatment and costs (rating, required)
• Were you seen at or near your appointment time? (multiple choice, required) — options: Yes within 5 minutes, Within 15 minutes, Within 30 minutes, Over 30 minute wait
• Would you return as a patient? (multiple choice, required) — options: Definitely, Probably, Unsure, Probably not, No
• What would improve the patient experience? (long text, optional)