January 1996
HOW ARE WE DOING? Baylor College of Dentistry is dedicated
to providing health care of the highest quality to our
patients. Your opinion of our services is necessary to
achieve this quality. Please take a few moments to complete
this survey and place it in one of the return boxes at any
of the Reception Desks. Thank you for helping us make Baylor
College of Dentistry a better place to receive dental
hygiene care. Sincerely, Richard Buchanan,
DMD Dean Baylor College of
Dentistry
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Please check the box that best describes your opinion. |
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Does Not Apply |
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1. I was pleased with the care provided by the Student Dental Hygienist. Add name if you can _____________________. |
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2. I was pleased with the Supervising Dentist. Add name if you can _____________________. |
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3. I was pleased with the Supervising Dental Hygienist. Add name if you can _____________________. |
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4. My student told me the truth. |
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5. My student was friendly. |
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6. My student talked to me with respect. |
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7. My student listened carefully and encouraged me to ask questions. |
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8. My student used words I could understand. |
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9. My student clearly explained the problems I have in my mouth. |
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10. My student clearly explained how to keep my mouth healthy. |
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11. My student gave me choices for my dental hygiene work and let me decide what to do. |
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12. My student explained what was going to happen before each procedure. |
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13. My student knew when I was in pain and did something about it. |
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14. My student used procedures that made me feel safe from catching a disease or infection. |
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15. My student wanted me to be happy with my dental hygiene work. |
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16. Overall, I was pleased with the care I received at Baylor College of Dentistry. |
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17. Did you have problems finding Baylor College of Dentistry? ___Yes ___No
Comment_____________________________________
18. Did you have problems with parking? ___Yes ___No
Comment_____________________________________
19. Did you have problems finding your dental hygiene student? ___Yes ___No
Comment_____________________________________
20. If this was your first appointment, were you given enough information? ___Yes ___No
Comment_____________________________________
21. Did you have problems with scheduling appointments? ___Yes ___No
Comment_____________________________________
22. Have you had any problems in contacting your student Dental Hygienist? ___Yes ___No
Comment_____________________________________
23. Did you have a comfortable place to sit while your were waiting for your student? ___Yes ___No
Comment_____________________________________
24. Did you think the treatment and waiting areas were clean? ___Yes ___No
Comment_____________________________________
25. Did you have to wait a long time for treatment at the Dental College? ___Yes ___No
Comment_____________________________________
26. Do you travel a long distance for your treatment? ___Yes ___No
Comment_____________________________________
27. Do you feel that the cost for your dental hygiene services was reasonable? ___Yes ___No
Comment_____________________________________
28. Would you recommend dental hygiene treatment at Baylor College of Dentistry to a friend or relative? ___Yes ___No
Comment_____________________________________
29. What was the best that happened to you at Baylor College of Dentistry?
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30. What was the worst that happened to you at Baylor College of Dentistry
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