Dental Office Patient Experience Feedback Form — Form Fields
This feedback template includes 8 fields. Gather patient feedback on appointment scheduling, wait time, and treatment comfort. Free to customize and use on ZenBuild.
Type of Visit (dropdown selection, required) — options: Routine Cleaning, Filling, Extraction, Root Canal, Orthodontics, Cosmetic, Emergency
Ease of Scheduling Appointment (rating, required)
Wait Time in Office (minutes) (number, required)
Front Desk Staff Friendliness (rating, required)
Dentist Communication and Thoroughness (rating, required)
Pain Management During Procedure (rating, required)
Were Costs Explained in Advance? (multiple choice, required) — options: Yes, Mostly, No
