{"id":2904,"date":"2023-10-04T13:58:51","date_gmt":"2023-10-04T13:58:51","guid":{"rendered":"https:\/\/epicpaws.modeltheme.com\/?page_id=2904"},"modified":"2026-04-28T14:35:43","modified_gmt":"2026-04-28T14:35:43","slug":"patient-satisfaction-survey","status":"publish","type":"page","link":"https:\/\/redsquaredentalcare.com\/index.php\/patient-satisfaction-survey\/","title":{"rendered":"Patient Satisfaction Survey"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2904\" class=\"elementor elementor-2904\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8c56650 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8c56650\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-bdbf4cd\" data-id=\"bdbf4cd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3e00671 e-n-tabs-mobile elementor-widget elementor-widget-n-tabs\" data-id=\"3e00671\" data-element_type=\"widget\" data-settings=\"{&quot;horizontal_scroll&quot;:&quot;disable&quot;}\" data-widget_type=\"nested-tabs.default\">\n\t\t\t\t\t\t\t<div class=\"e-n-tabs\" data-widget-number=\"65013361\" aria-label=\"Tabs. Open items with Enter or Space, close with Escape and navigate using the Arrow keys.\">\n\t\t\t<div class=\"e-n-tabs-heading\" role=\"tablist\">\n\t\t\t\t\t<button id=\"e-n-tab-title-650133611\" class=\"e-n-tab-title\" aria-selected=\"true\" data-tab-index=\"1\" role=\"tab\" tabindex=\"0\" aria-controls=\"e-n-tab-content-650133611\" style=\"--n-tabs-title-order: 1;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tENGLISH\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t<button id=\"e-n-tab-title-650133612\" class=\"e-n-tab-title\" aria-selected=\"false\" data-tab-index=\"2\" role=\"tab\" tabindex=\"-1\" aria-controls=\"e-n-tab-content-650133612\" style=\"--n-tabs-title-order: 2;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tSPANISH\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t\t<\/div>\n\t\t\t<div class=\"e-n-tabs-content\">\n\t\t\t\t<div id=\"e-n-tab-content-650133611\" role=\"tabpanel\" aria-labelledby=\"e-n-tab-title-650133611\" data-tab-index=\"1\" style=\"--n-tabs-title-order: 1;\" class=\"e-active elementor-element elementor-element-881e546 e-con-full e-flex e-con e-child\" data-id=\"881e546\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-2ae64b7 e-flex e-con-boxed e-con e-child\" data-id=\"2ae64b7\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ad84ce4 elementor-widget elementor-widget-mtfe-contact-form\" data-id=\"ad84ce4\" data-element_type=\"widget\" data-widget_type=\"mtfe-contact-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"mt-addons-contact-form\" id=\"mt-addons-contact-form-69f211a31158a\">\r\n            \n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3185-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"3185\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/2904#wpcf7-f3185-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"3185\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.2\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3185-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h3>Patient Information\n<\/h3>\n<p><label>Name:<\/label><br \/>\n<input type=\"text\" name=\"patient-name\" \/>\n<\/p>\n<p><label>Date of Visit:<\/label><br \/>\n<input type=\"date\" name=\"date-of-visit\" \/>\n<\/p>\n<p><label>Dr.:<\/label><br \/>\n<input type=\"text\" name=\"doctor-name\" \/>\n<\/p>\n<h3>1. Appointment Experience\n<\/h3>\n<p>How easy was it to schedule your appointment?\n<\/p>\n<p><label><input type=\"radio\" name=\"schedule-ease\" value=\"Very Easy\" \/> Very Easy<\/label><br \/>\n<label><input type=\"radio\" name=\"schedule-ease\" value=\"Easy\" \/> Easy<\/label><br \/>\n<label><input type=\"radio\" name=\"schedule-ease\" value=\"Neutral\" \/> Neutral<\/label><br \/>\n<label><input type=\"radio\" name=\"schedule-ease\" value=\"Difficult\" \/> Difficult<\/label><br \/>\n<label><input type=\"radio\" name=\"schedule-ease\" value=\"Very Difficult\" \/> Very Difficult<\/label>\n<\/p>\n<p>Were you seen on time?\n<\/p>\n<p><label><input type=\"radio\" name=\"seen-on-time\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"seen-on-time\" value=\"No\" \/> No<\/label>\n<\/p>\n<p>Was the doctor friendly and helpful?\n<\/p>\n<p><label><input type=\"radio\" name=\"doctor-friendly\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"doctor-friendly\" value=\"Somewhat\" \/> Somewhat<\/label><br \/>\n<label><input type=\"radio\" name=\"doctor-friendly\" value=\"No\" \/> No<\/label>\n<\/p>\n<p>How would you rate your dental\/orthodontic treatment?\n<\/p>\n<p><label><input type=\"radio\" name=\"treatment-rating\" value=\"Excellent\" \/> Excellent<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-rating\" value=\"Good\" \/> Good<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-rating\" value=\"Fair\" \/> Fair<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-rating\" value=\"Poor\" \/> Poor<\/label>\n<\/p>\n<p>Did we explain your treatment clearly?\n<\/p>\n<p><label><input type=\"radio\" name=\"treatment-explained\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-explained\" value=\"Somewhat\" \/> Somewhat<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-explained\" value=\"No\" \/> No<\/label>\n<\/p>\n<p>Did you feel comfortable during your visit?\n<\/p>\n<p><label><input type=\"radio\" name=\"comfortable-visit\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"comfortable-visit\" value=\"Somewhat\" \/> Somewhat<\/label><br \/>\n<label><input type=\"radio\" name=\"comfortable-visit\" value=\"No\" \/> No<\/label>\n<\/p>\n<h3>2. Front Office Experience\n<\/h3>\n<p>How would you rate our front desk staff?\n<\/p>\n<p><label><input type=\"radio\" name=\"front-desk-rating\" value=\"Excellent\" \/> Excellent<\/label><br \/>\n<label><input type=\"radio\" name=\"front-desk-rating\" value=\"Good\" \/> Good<\/label><br \/>\n<label><input type=\"radio\" name=\"front-desk-rating\" value=\"Fair\" \/> Fair<\/label><br \/>\n<label><input type=\"radio\" name=\"front-desk-rating\" value=\"Poor\" \/> Poor<\/label>\n<\/p>\n<h3>3. Cleanliness & Environment\n<\/h3>\n<p>How would you rate the cleanliness of our office?\n<\/p>\n<p><label><input type=\"radio\" name=\"cleanliness-rating\" value=\"Excellent\" \/> Excellent<\/label><br \/>\n<label><input type=\"radio\" name=\"cleanliness-rating\" value=\"Good\" \/> Good<\/label><br \/>\n<label><input type=\"radio\" name=\"cleanliness-rating\" value=\"Fair\" \/> Fair<\/label><br \/>\n<label><input type=\"radio\" name=\"cleanliness-rating\" value=\"Poor\" \/> Poor<\/label>\n<\/p>\n<h3>4. Overall Experience\n<\/h3>\n<p>Overall, how satisfied are you with your visit?\n<\/p>\n<p><label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Very Satisfied\" \/> Very Satisfied<\/label><br \/>\n<label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Satisfied\" \/> Satisfied<\/label><br \/>\n<label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Neutral\" \/> Neutral<\/label><br \/>\n<label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Unsatisfied\" \/> Unsatisfied<\/label><br \/>\n<label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Very Unsatisfied\" \/> Very Unsatisfied<\/label>\n<\/p>\n<p>Would you recommend our office to family and friends?\n<\/p>\n<p><label><input type=\"radio\" name=\"recommend-office\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"recommend-office\" value=\"No\" \/> No<\/label>\n<\/p>\n<h3>5. How did you hear about us?\n<\/h3>\n<p><label><input type=\"checkbox\" name=\"heard-about-us\" value=\"Friend\/Family\/Doctor\" \/> Friend \/ Family \/ Doctor<\/label><br \/>\n<label><input type=\"checkbox\" name=\"heard-about-us\" value=\"Mail\" \/> Mail<\/label><br \/>\n<label><input type=\"checkbox\" name=\"heard-about-us\" value=\"Social Media\" \/> Social Media<\/label><br \/>\n<label><br \/>\nOther:<br \/>\n<input type=\"text\" name=\"heard-about-us-other\" \/><br \/>\n<\/label>\n<\/p>\n<h3>Additional Feedback\n<\/h3>\n<p><textarea name=\"additional-feedback\" rows=\"5\"><\/textarea>\n<\/p>\n<p>Thank you for your feedback!\n<\/p>\n<p><button type=\"submit\">Submit Survey<\/button>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n        <\/div>\r\n\r\n    \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div id=\"e-n-tab-content-650133612\" role=\"tabpanel\" aria-labelledby=\"e-n-tab-title-650133612\" data-tab-index=\"2\" style=\"--n-tabs-title-order: 2;\" class=\" elementor-element elementor-element-73beef8 e-con-full e-flex e-con e-child\" data-id=\"73beef8\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-cab58d9 e-flex e-con-boxed e-con e-child\" data-id=\"cab58d9\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2d2ef3c elementor-widget elementor-widget-mtfe-contact-form\" data-id=\"2d2ef3c\" data-element_type=\"widget\" data-widget_type=\"mtfe-contact-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"mt-addons-contact-form\" id=\"mt-addons-contact-form-69f211a312f16\">\r\n            \n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3185-o2\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"3185\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/2904#wpcf7-f3185-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"3185\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.2\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3185-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h3>Patient Information\n<\/h3>\n<p><label>Name:<\/label><br \/>\n<input type=\"text\" name=\"patient-name\" \/>\n<\/p>\n<p><label>Date of Visit:<\/label><br \/>\n<input type=\"date\" name=\"date-of-visit\" \/>\n<\/p>\n<p><label>Dr.:<\/label><br \/>\n<input type=\"text\" name=\"doctor-name\" \/>\n<\/p>\n<h3>1. Appointment Experience\n<\/h3>\n<p>How easy was it to schedule your appointment?\n<\/p>\n<p><label><input type=\"radio\" name=\"schedule-ease\" value=\"Very Easy\" \/> Very Easy<\/label><br \/>\n<label><input type=\"radio\" name=\"schedule-ease\" value=\"Easy\" \/> Easy<\/label><br \/>\n<label><input type=\"radio\" name=\"schedule-ease\" value=\"Neutral\" \/> Neutral<\/label><br \/>\n<label><input type=\"radio\" name=\"schedule-ease\" value=\"Difficult\" \/> Difficult<\/label><br \/>\n<label><input type=\"radio\" name=\"schedule-ease\" value=\"Very Difficult\" \/> Very Difficult<\/label>\n<\/p>\n<p>Were you seen on time?\n<\/p>\n<p><label><input type=\"radio\" name=\"seen-on-time\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"seen-on-time\" value=\"No\" \/> No<\/label>\n<\/p>\n<p>Was the doctor friendly and helpful?\n<\/p>\n<p><label><input type=\"radio\" name=\"doctor-friendly\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"doctor-friendly\" value=\"Somewhat\" \/> Somewhat<\/label><br \/>\n<label><input type=\"radio\" name=\"doctor-friendly\" value=\"No\" \/> No<\/label>\n<\/p>\n<p>How would you rate your dental\/orthodontic treatment?\n<\/p>\n<p><label><input type=\"radio\" name=\"treatment-rating\" value=\"Excellent\" \/> Excellent<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-rating\" value=\"Good\" \/> Good<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-rating\" value=\"Fair\" \/> Fair<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-rating\" value=\"Poor\" \/> Poor<\/label>\n<\/p>\n<p>Did we explain your treatment clearly?\n<\/p>\n<p><label><input type=\"radio\" name=\"treatment-explained\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-explained\" value=\"Somewhat\" \/> Somewhat<\/label><br \/>\n<label><input type=\"radio\" name=\"treatment-explained\" value=\"No\" \/> No<\/label>\n<\/p>\n<p>Did you feel comfortable during your visit?\n<\/p>\n<p><label><input type=\"radio\" name=\"comfortable-visit\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"comfortable-visit\" value=\"Somewhat\" \/> Somewhat<\/label><br \/>\n<label><input type=\"radio\" name=\"comfortable-visit\" value=\"No\" \/> No<\/label>\n<\/p>\n<h3>2. Front Office Experience\n<\/h3>\n<p>How would you rate our front desk staff?\n<\/p>\n<p><label><input type=\"radio\" name=\"front-desk-rating\" value=\"Excellent\" \/> Excellent<\/label><br \/>\n<label><input type=\"radio\" name=\"front-desk-rating\" value=\"Good\" \/> Good<\/label><br \/>\n<label><input type=\"radio\" name=\"front-desk-rating\" value=\"Fair\" \/> Fair<\/label><br \/>\n<label><input type=\"radio\" name=\"front-desk-rating\" value=\"Poor\" \/> Poor<\/label>\n<\/p>\n<h3>3. Cleanliness & Environment\n<\/h3>\n<p>How would you rate the cleanliness of our office?\n<\/p>\n<p><label><input type=\"radio\" name=\"cleanliness-rating\" value=\"Excellent\" \/> Excellent<\/label><br \/>\n<label><input type=\"radio\" name=\"cleanliness-rating\" value=\"Good\" \/> Good<\/label><br \/>\n<label><input type=\"radio\" name=\"cleanliness-rating\" value=\"Fair\" \/> Fair<\/label><br \/>\n<label><input type=\"radio\" name=\"cleanliness-rating\" value=\"Poor\" \/> Poor<\/label>\n<\/p>\n<h3>4. Overall Experience\n<\/h3>\n<p>Overall, how satisfied are you with your visit?\n<\/p>\n<p><label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Very Satisfied\" \/> Very Satisfied<\/label><br \/>\n<label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Satisfied\" \/> Satisfied<\/label><br \/>\n<label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Neutral\" \/> Neutral<\/label><br \/>\n<label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Unsatisfied\" \/> Unsatisfied<\/label><br \/>\n<label><input type=\"radio\" name=\"overall-satisfaction\" value=\"Very Unsatisfied\" \/> Very Unsatisfied<\/label>\n<\/p>\n<p>Would you recommend our office to family and friends?\n<\/p>\n<p><label><input type=\"radio\" name=\"recommend-office\" value=\"Yes\" \/> Yes<\/label><br \/>\n<label><input type=\"radio\" name=\"recommend-office\" value=\"No\" \/> No<\/label>\n<\/p>\n<h3>5. How did you hear about us?\n<\/h3>\n<p><label><input type=\"checkbox\" name=\"heard-about-us\" value=\"Friend\/Family\/Doctor\" \/> Friend \/ Family \/ Doctor<\/label><br \/>\n<label><input type=\"checkbox\" name=\"heard-about-us\" value=\"Mail\" \/> Mail<\/label><br \/>\n<label><input type=\"checkbox\" name=\"heard-about-us\" value=\"Social Media\" \/> Social Media<\/label><br \/>\n<label><br \/>\nOther:<br \/>\n<input type=\"text\" name=\"heard-about-us-other\" \/><br \/>\n<\/label>\n<\/p>\n<h3>Additional Feedback\n<\/h3>\n<p><textarea name=\"additional-feedback\" rows=\"5\"><\/textarea>\n<\/p>\n<p>Thank you for your feedback!\n<\/p>\n<p><button type=\"submit\">Submit Survey<\/button>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n        <\/div>\r\n\r\n    \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>ENGLISH SPANISH Patient Information Name: Date of Visit: Dr.: 1. Appointment Experience How easy was it to schedule your appointment? Very Easy Easy Neutral Difficult Very Difficult Were you seen on time? Yes No Was the doctor friendly and helpful? Yes Somewhat No How would you rate your dental\/orthodontic treatment? Excellent Good Fair Poor Did [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2904","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/redsquaredentalcare.com\/index.php\/wp-json\/wp\/v2\/pages\/2904","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/redsquaredentalcare.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/redsquaredentalcare.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/redsquaredentalcare.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/redsquaredentalcare.com\/index.php\/wp-json\/wp\/v2\/comments?post=2904"}],"version-history":[{"count":27,"href":"https:\/\/redsquaredentalcare.com\/index.php\/wp-json\/wp\/v2\/pages\/2904\/revisions"}],"predecessor-version":[{"id":15476,"href":"https:\/\/redsquaredentalcare.com\/index.php\/wp-json\/wp\/v2\/pages\/2904\/revisions\/15476"}],"wp:attachment":[{"href":"https:\/\/redsquaredentalcare.com\/index.php\/wp-json\/wp\/v2\/media?parent=2904"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}