Brian J. Lord, D.D.S : South Jordan Utah Dentist - Bangerter Hwy & 10400 S * South Jordan, Daybreak * (801)253-2249
Tell Us What You Think
 
 
We are always looking for new ways to improve; and if we are doing something right, we would like to know that too!  This survey is completely confidential. 
 
Please answer any or all of the following questions:
1) Select your privacy
You may use my first name and comments
You may use my comments, but not my name
Don't use my comments or my name
2) Your name (Optional)
3) When was your appointment?
Within the last week
Within the last month
Did not have one
Would rather not say
4) Your visit was for:
Examination (cleaning)
Treatment (fillings, crown, root canal, etc.)
Neither
5) How long did you wait before you were seen?
Less than 5 minutes
5-10 minutes
11-20 minutes
21-30 minutes
More than 30 minutes
6) Was the time you waited:
Longer
Shorter
As expected
7) Did our front office person make you feel welcome?
Yes
No
No opinion
8) Did our dental assistant make you feel comfortable?
Yes
No
No opinion
9) The staff were knowledgeable.
Strongly Agree
Agree
No opinion
Disagree
Strongly Disagree
10) Did Dr. Lord meet your dental health needs?
Yes
No
No opinion
11) Do you feel the purpose of your visit was fulfilled?
Yes
No
12) Do you feel you were given all the options for your treatment plan?
Yes
No
Not applicable
13) Do you feel like you participated in choosing your planned treatment?
Yes
No
Not applicable
14) How likely are you to recommend our practice to a friend or family member?
Very likely
Likely
Neutral
Not likely
Never
15) On a scale from 1 to 10, how likely are you to return to our office?
16) What was the #1 reason for choosing us?
Evening appointments
Saturday appointments
Location
Takes my insurance
Referred by a friend
17) What is the most important quality you look for when choosing a dental practice?
18) Please use the space below to share any of your opinions (positive or negative) to help us better serve you and others:
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