Patient Survey

We would like to thank you for selecting Southgate Dental as your dental practice. We have been proudly serving and catering the needs of our patients for over 20 years.

To improve our services, we would kindly ask you to complete this small survey. It will help us to better serve you and your family.

Please let us know how we are doing in the following areas.

Name (optional):
Contact Number (optional):
Name of the Doctor you visited:

Survey Details

1. How would you rate your visit at Southgate Dental’s office?

2. Did you receive a warm welcome and friendly greeting from the staff when you entered our office?

3. Do you find our staff polite, courteous and helpful while taking up your queries over the phone?

4. Did the dentist and assistants take an adequate amount of time to explain your treatment and answer your questions?

5. How long do you usually have to wait in the reception area of our clinic before your appointment?

6. How would you rate the professionalism and conduct of the staff at the clinic?

7. Were all the possible financial options and billing questions explained to you by our staff?

8. Would you refer your friends and family to visit Southgate Dental for dental treatment?

9. Who were you here to see today?

10. Was your diagnosis, treatment plan and options presented in a clear, concise manner that was easy to understand?

11. How would you rate our preventive dentistry and hygiene program?

12. Would you feel comfortable in referring Dr. Bhargava or Dr. Telang to your friends and family?

Please feel free to write down additional comments or recommendations you have.