Dental Office Receptionist Feedback Form
We value your feedback. Please share your experience with our front desk receptionist to help us improve our service.
Your Name (Optional)
First Name
Last Name
Date of Your Visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Your Visit
*
Please Select
Routine Check-up
Cleaning
Emergency
Consultation
Other
How would you rate the receptionist's courtesy and friendliness?
*
1
2
3
4
5
How would you rate the receptionist's professionalism?
*
1
2
3
4
5
How helpful was the receptionist in answering your questions or addressing your needs?
*
1
2
3
4
5
How would you rate the receptionist's communication skills?
*
1
2
3
4
5
Receptionist Feedback Matrix
*
Rows
Excellent
Good
Fair
Poor
Greeting upon arrival
1
2
3
4
Wait time explanation
5
6
7
8
Appointment scheduling
9
10
11
12
Handling of paperwork
13
14
15
16
Was your check-in process handled efficiently?
*
Yes
No
Would you recommend our dental office based on your front desk experience?
*
Definitely
Probably
Not Sure
Probably Not
Definitely Not
Please share any additional comments or suggestions regarding your experience with our receptionist.
Submit Feedback
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