Dental Clinic Questionnaire

Topics: Dentistry, Dental implant Pages: 3 (270 words) Published: April 6, 2011
Name : Date :

1. Have you ever been to a dentist ?
- Yes(
- No(
- Don’t have a dentist(
2. How do you select a dentist ?
- Ask friends, neighbors, co-workers(
- Enquire on yellow pages / just dial(
- Ask your family doctor(
- Closest to the place of residence(
- Any Other _________________________________________

3. How occasionally do you visit a dentist ?
- Once a year(
- Twice a year(
- More than 2 times a year(
- Only in emergencies(

4. Are there any apprehensions in your mind before visiting a dentist ? - Apprehensions related to pain(
- Apprehensions related to price(
- Apprehensions related to hygiene(
- Apprehensions related to technology(
- Any Other _________________________________________

5. Which dentist do you visit ? ________________________________________________________

6. Since when are you visiting the dentist ?
- 1 – 3 years(
- 3 – 5 years(
- 5 – 7 years(
- More than 7 years(

7. Any particular reason for visiting the above mentioned dentist ? ________________________________________________________

8. How satisfied are you with your dentist ?
( |( |( |( |( |( |( | |Very Satisfied | | | | | |Dissatisfied | |

9. What do you find the least appealing about your dentist ? - Price(
- Lack of technology(
- Behavior of the dentist(
- Pain(
- Lack of convenience of time(
- Lack of hygiene(
- Ambience(
- None of the above(

10. How important are the following factors when selecting a dentist? ( Rank them in the order of importance ) - Affordability...
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