Aspen Ridge Dental Survey
RequiredRequired Question(s)
1.

What was the purpose of your last visit to Aspen Ridge Dental?

 

General Cleaning and Exam
Toothache
Filling/Cavity
Dental Impants
Root Canal
Other  
Required 2.

How did you hear of Aspen Ridge Dental?

 

 

Referral
Phonebook
Newspaper Advertisment
Radio Advertisement
Television Advertisment
Internet Search
Other  
  • Comment:

  • 500 characters left.
Required 3.

Why did you choose Aspen Ridge Dental for your dental healthcare needs?

 

 

 

Professionalism
Quality of Patient Care
Specific Services Provided
Referred by a Current Patient
Other  
Required 4.

How long have you been a patient with Aspen Ridge Dental?

 

Less than 1 year
1-2 Years
2-4 Years
More than 5 years
5.

When you arrived, how would you rate the assistance you received from the receptionist?

 

 

Prompt and Helpful
Helpful after I asked
Slow and Unhelpful
Rude
6.

Did the dentist/hygienist take the time to listen to and understand your concerns?

 

Yes
Somewhat
No
  • Comment:

  • 500 characters left.
7.

Did the dentist/hygienist take the time to adequately explain the treatment plan and answer your questions?

 

Yes
Somewhat
No
  • Comment:

  • 500 characters left.
8.

Did you feel that you understood the prescribed treatment, and were all of your questions answered to your satisfaction?

 

 

 

Yes
Somewhat
No
  • Comment:

  • 500 characters left.
9.

If you had a concern during your last visit, do you think it was properly handled by the staff?

 

Yes
Somewhat
No
  • Comment:

  • 500 characters left.
10.

Are you comfortable with the level of technology used at Aspen Ridge Dental?

 

Yes
Somewhat
No
  • Comment:

  • 500 characters left.
Required 11.

How would you rate the physical condition and overall cleanliness of Aspen Ridge Dental?

 

Excellent
Good
Fair
Poor
  • Comment:

  • 500 characters left.
Required 12.

Do other members of your family use Aspen Ridge Dental?

 

Yes
No
Required 13.

If Aspen Ridge Dental were to offer new services, what is the best way for them to communicate those new services to you?

 

Mailer
E-mail
On Their Invoice
Service Person Contacting You
Newspaper
Television
Radio
Other  
Required 14.

How can Aspen Ridge Dental improve their service?

 

Customer Service
Offer Additional Services
Pricing
Better or More Frequent Promotions
Referral Program
Other  
  • Comment:

  • 500 characters left.
Required 15.

If you were to suggest Aspen Ridge Dental to a friend, what would you say about Aspen Ridge Dental?

 

 

Compassionate Serivce Provided
Professionalism
Provides Cutting Edge Technology
Friendly Staff and Environment
  • Comment:

  • 500 characters left.
Required 16.

Rate your overall satisfaction with Aspen Ridge Dental.

 

Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
  • Comment:

  • 500 characters left.
Required 17.

Have you seen any of Aspen Ridge Dental's past advertising efforts?

 

Yes
No
Required 18.

If you have seen Aspen Ridge Dental's past advertising, where?

 

Newspaper
Television
Radio
Internet
Mailer
E-mail
Phonebook
None of the Above
Required 19.

Do you subscribe to the Casper Star Tribune?

 

Yes
No
Required 20.

Is there a certain day of the week that you read the Casper Star Tribune?

 

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
  • Comment:

  • 500 characters left.
Required 21.

 Is there a certain section of the paper you always read? If so, which section?

 

Yes
No
  • Comment:

  • 500 characters left.
Required 22.

Do you read the Casper Journal?

 

Yes
No
Required 23.

Do you read Our Town Casper?

 

Yes
No
Required 24.

Do you watch TV daily?

 

Yes
No
Required 25.

How many hours per week do you watch TV?

 

0-5 Hours
6-15 Hours
16-25 Hours
More Than 25 Hours
Required 26.

Which local newscasts do you watch?

 

KCWY-13 At 5pm
KCWY-13 At 6pm
KCWY-13 At 10pm
KTWO-6 At 5pm
KTWO-6 At 6pm
KTWO-6 At 10pm
Required 27.

Do you watch either local morning show?

 

KCWY-13 Today in Wyoming
KTWO-6 K2 News
Neither
Required 28.

How do you get your weather information?

 

Newspaper
Television
Radio
Internet
Just Walk Outside
None of the Above
Required 29.

Do you listen to local radio? If yes which radio stations?

 

Yes
No
  • Comment:

  • 500 characters left.
Required 30.

Do you listen to satellite radio?

 

Yes
No
Required 31.

Do you recognize/notice billboards? If yes, what was the last billboard you saw?

 

Yes
No
  • Comment:

  • 500 characters left.
Required 32.

Which phonebook do you use?

 

Qwest Dex
Phone Directories
Union
Internet Search
Required 33.

Do you use the internet to find phone numbers for local business before you look in the phone book?

 

Yes
No
Required 34.

Are you on the internet daily? If yes, how much time do you spend weekly on the internet?

 

Yes
No
  • Comment:

  • 500 characters left.
Required 35.

Do you notice postcards when you get them in the mail?

 

Yes
No
Required 36.

If you were looking to replace Aspen Ridge Dental, how would you go about looking?

 

Phonebook Search
Internet Search
Television
Radio
Newspaper
Ask a friend
Other  
37.

In order to be lncluded in our drawing, please provide the following contact information. 

 


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
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