QUINSIGAMOND COMMUNITY COLLEGE
Dental Program
 Dental Hygiene Patient Survey

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This is an anonymous survey!  

DIRECTIONS:
Please check-off answers to each of the questions listed below according to the indicated topic, question and scale.   Add your comments where indicated.   

Using the indicated scale, please check the circle that best describes your opinion.

      SA   -  Strongly Agree
      A    -   Agree 
      NB  -  No Bias  
      D    -   Disagree
      SD  -  Strongly Disagree
      NA -  Not Applicable 
 
1.  I was pleased with the care provided by the Student Dental Hygienist. SA
 A
 NB
 D
 SD
 NA
2.  I was pleased with the Supervising Dentist. SA
 A
 NB
 D
 SD
 NA
3.  I was pleased with the Supervising Dental Hygienist. SA
 A
 NB
 D
 SD
 NA
4.  My student was friendly. SA
 A
 NB
 D
 SD
 NA
5.  My student talked to me with respect. SA
 A
 NB
 D
 SD
 NA
6.  My student listened carefully and encouraged me to ask questions. SA
 A
 NB
 D
 SD
 NA
7.  My student used words I could understand. SA
 A
 NB
 D
 SD
 NA
8.  My student clearly explained the problems I have in my mouth. SA
 A
 NB
 D
 SD
 NA
9.  My student clearly explained how to keep my mouth healthy. SA
 A
 NB
 D
 SD
 NA
10.  My student explained what was going to happen before each procedure. SA
 		A
 		NB
 D
 		SD
 		NA
11.  My student knew when I was in pain and did something about it. SA
 		A
 NB
 D
 		SD
 NA
12.  My student used procedures that made me feel safe from catching a disease or infection. SA
 		A
 		NB
 D
 		SD
 		NA
13.  My student wanted me to be happy with my dental hygiene work. SA
 A
 		NB
 D
 		SD
 NA
14.  Overall, I was pleased with the care I received at the Quinsigamond Community College Dental Hygiene Clinic. SA
 A
 		NB
 D
 		SD
 NA
Please answer the following 'Yes' or 'No' and provide any comment you wish.
15.  Did you have problems finding Quinsigamond Community College? Yes No

Question 15 commentary.

16.

  Did you have problems with parking? Yes No

Question 16 commentary.
17.  Did you have problems finding the clinic? Yes No

Question 17 commentary.
18.  If this was your first appointment, were you given enough information? Yes No

Question 18 commentary.
19.  Did you have problems with scheduling appointments? Yes No

Question 19 commentary.
20.  Have you had any problems in contacting your student Dental Hygienist? Yes No

Question 20 commentary.
21.  Did you have a comfortable place to sit while you were waiting for your student? Yes No

Question 21 commentary.
22.  Did you think the treatment and waiting areas were clean? Yes No

Question 22 commentary.
23.  Did you have to wait a long time for treatment at Quinsigamond Community College? Yes No

Question 23 commentary.
24.  Do you travel a long distance for your treatment? Yes No

Question 24 commentary.
25.  Do you feel that the cost for your dental hygiene services was reasonable? Yes No

Question 25 commentary.
26.  Would you recommend dental hygiene treatment at Quinsigamond Community College to a friend or relative? Yes No

Question 26 commentary.
What was the best that happened to you at the Quinsigamond Community College
Dental Hygiene Clinic?
What was the worst that happened to you at the Quinsigamond Community College
Dental Hygiene Clinic?

Thank You for Taking the Time to Complete This Survey.

Please click this button to submit the Survey: 

 

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