Dental Equipment Service Technician Customer Satisfaction Survey Form
Please help us improve by sharing your feedback on your recent experience with our dental equipment service technician.
Date of Service
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Equipment Serviced
*
Please Select
Dental Chair
Imaging Equipment
Sterilization Unit
Handpiece
Compressor/Vacuum
Other
Technician Name or ID (if known)
How satisfied were you with the technician's professionalism?
*
Very Dissatisfied
1
2
3
4
Very Satisfied
5
1 is Very Dissatisfied, 5 is Very Satisfied
How would you rate the technician's communication?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How satisfied were you with the timeliness of the service?
*
Very Dissatisfied
1
2
3
4
Very Satisfied
5
1 is Very Dissatisfied, 5 is Very Satisfied
Was your issue resolved to your satisfaction?
*
Yes
Partially
No
How likely are you to recommend our service technician to others?
*
Not at all likely
0
1
2
3
4
5
6
7
8
9
Extremely likely
10
0 is Not at all likely, 10 is Extremely likely
What did you appreciate most about the service?
Promptness
Expertise
Courtesy
Clear Explanations
Thoroughness
Other
Additional comments or suggestions
Submit Feedback
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