Reaching Others
SEARCH SDM

Home
 
About the School
 
Departments
 
Education
 
Research
 
Community Outreach
 
Alumni
 
Patients
 
Support the School
 PatientsSurvey     September 1, 2014  

General Clinic Information

University at Buffalo
State University of New York
School of Dental Medicine
158 Squire Hall
Buffalo, NY 14214

Phone: (716) 829-2824
E-mail: harrisjm@buffalo.edu



 


 





Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving our services. All responses will be kept confidential and anonymous. If you have a concern you would like to discuss with the Patient Advocate please call 716-829-2390.

Please indicate how well we are doing in the following areas (you may leave responses blank for questions that don't apply to you):


(NA = Not Applicable)
NA Great Good OK Fair Poor
- 5 4 3 2 1
Appointments
Easy to make NA 5 4 3 2 1
Provided in a reasonable time frame NA 5 4 3 2 1
Provider / Student, Resident, Hygienist
Listens to you NA 5 4 3 2 1
Addressed your questions or concerns NA 5 4 3 2 1
Clearly explains procedures/treatment NA 5 4 3 2 1
Faculty
Available for provider (student) when needed NA 5 4 3 2 1
Facility
Neat and clean building NA 5 4 3 2 1
Ease of finding where to o NA 5 4 3 2 1
Hours of operation NA 5 4 3 2 1
Parking NA 5 4 3 2 1
Valet NA 5 4 3 2 1
Staff
Friendly and helpful NA 5 4 3 2 1
Payment / Billing
Reasonable fees NA 5 4 3 2 1
Charges explained NA 5 4 3 2 1
Confidentiality
Personal information kept private NA 5 4 3 2 1

Likelihood of referring your friends and relatives NA 5 4 3 2 1
Overall experience NA 5 4 3 2 1

Great Good OK Fair Poor
5 4 3 2 1

What is the reason you chose to have dental care performed at UB Dental? (select all that apply)
Quality of treatment/ reputation
Reasonable cost
Participates with insurance
Location
Other - please specify:

Do you plan on returning to UB Dental? YES NO
If not, why not?
What is your gender? NA FEMALE MALE
What is your age? NA UNDER 18 18 TO 30 31 TO 50 51 TO 65 OVER 65
What is your race/ ethnicity? NA CAUCASION AFRICAN AMERICAN HISPANIC ASIAN OTHER
What is your household income?
NA
LESS THAN $19,999
$20,000 TO $39,999
$40,000 TO $74,999
$75,000 TO $99,999
GREATER THAN $100K
How did you hear about UB Dental?
HOWHEAR
FRIEND / RELATIVE
BROCHURE
HEALTH FAIR
INFORMATION SESSION
OTHER

What type of service did you receive?
Exam / Cleaning / X-rays
Fillings/ Crown / Bridge
Partial Denture / Denture
Extraction
Root canal
Implant
Other

Comments:

Submit Form

 Copyright (c) 2014 UB School of Dental Medicine   Privacy Statement