941

In line with our practice accreditation and ADHPL operational policies (SOP) and in compliance with the Australian Patient Healthcare Charter duly adopted by our practice, our staff and management must seek regular feedback from colleagues and patients and review and act upon that feedback where appropriate.

The purpose of this exercise is to provide our clinical and administrative staff with information about their work through the eyes of those they work with and treat, and is intended to help inform their further development.

Please select the box as appropriate and base your answers on your latest visit at our practice. If you change your mind just cross out your old response and make your new choice. Please answer all questions before submitting.

Please note: Your feedback may be used for internal staff training, coaching and quality improvements.

Date of survey: *

Location of Service Received: *

Myaree Clinic
Willagee Clinic

Are you: *

Female
Male

Are you mostly anxious/nervous when attending a dentist? *

YES
NO
Can’t Say

Your most recent service date: *

Serving Dentist: *

Dr. Katherine LAU
Dr. Ramanjit KAUR
Dr. William REIDY

Serving Assistant: *

Amanda KAAS-RASMUSSEN
Puneet KAUR
Sediqa HASSANI

Your purpose of visit to dental practice today? (Please tick all the boxes that apply) *

Professional Consultation, Diagnostics and Radiographic Analysis
Further discussion of your treatment plan, related financials, quotations and health fund rebates
For a routine check-up and scale and clean
Because of an ongoing problem
For treatment as mutually discussed and consented by myself
Because of one or more dental/oral problems (such as tooth ache, chipped tooth, jaw ache,, abnormal growth/cysts, mouth guards, snoring and sleep problems, crooked or mal-aligned teeth, swollen/bleeding gums, stained teeth, accident, etc)

Other (please specify)

Your Serving Dental Practitioner

How good was your general dentist today at each of the following key performance attributes? (Please tick one box in each line)

Your Overall Experience at the practice:

Was this visit with your usual dentist at the practice? *

Yes
No
Can’t say

I am confident about this dentist’s ability to provide care *

Yes
No
Can’t say

I am confident about the other auxiliary staff’s ability to provide care *

Yes
No
Can’t say

I would be completely happy to see this dentist again *

Yes
No
Can’t say

I would be happy to recommend this dentist to others *

Yes
No
Can’t say

Overall, I am satisfied with the services received at the clinic *

Yes
No
Can’t say

I am happy to recommend my friends/relatives to this practice *

Yes
No
Can’t say

I wish to add other comments, concerns, service quality improvements or changes addressed to the practice management for their consideration.

Privacy *

I do not wish to remain anonymous as part of this survey and happy disclose my personal contact details
I wish to remain anonymous and prefer not to provide by personal contact details within this survey

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