Q01
Message
All templatesHealthcare & Clinical
Dental Patient Experience & Satisfaction Survey
Measures how patients experience each stage of a dental visit — booking, wait times, pain management, cost transparency, and trust in the dentist — and what drives their willingness to recommend the practice. Built for dental practices and group practices benchmarking patient experience, with an AI follow-up that uncovers the real story behind low or high recommendation scores, especially around anxiety and trust.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
12 questions · ~7 min
Q02
Multiple ChoiceRequired
What was the main reason for your most recent dental visit?
- Routine checkup and cleaning
- Specific procedure (filling, crown, root canal, etc.)
- Dental emergency (pain, injury, broken tooth)
- Cosmetic treatment (whitening, veneers, etc.)
- Other
Q03
Multiple ChoiceRequired
In the last 2 years, how many times have you visited a dentist?
- 3 or more times
- Twice
- Once
- Not at all
Q04
MatrixRequired
Thinking about your most recent visit, how would you rate each of the following?
6 rows × 5 columns
- Wait time before being seen
- Friendliness of front-desk and clinical staff
- How clearly the dentist explained your treatment
- Management of pain or discomfort during treatment
- Cleanliness of the office
- +1 more
Columns: Poor · Fair · Good · Very good · Excellent
Q05
Opinion ScaleRequired
How likely are you to recommend this dental practice to a friend or family member?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q06
Best–Worst Trade-off (MaxDiff)Required
When choosing a dental practice, which of these matter most to you and which matter least?
- Appointment availability that fits my schedule
- Clear, upfront pricing
- Friendly, approachable staff
- Modern equipment and technology
- Minimal wait times
- Insurance and payment plan options
- Clear explanations of treatment and next steps
- Gentle, low-pain procedures
Pick best & worst per setBest:Matters mostWorst:Matters least
Q07
Multiple Choice
In the last 2 years, has dental anxiety ever caused you to delay or skip a recommended appointment?
- Yes, more than once
- Yes, once
- No, never
- I don't experience dental anxiety
Q08
AI Interview
Probe the reasoning behind the respondent's recommendation score: ask them to describe the specific moment or interaction that most shaped that score, whether positive or negative. If they reported dental anxiety or a low rating on pain management or cost transparency, dig into what exactly happened, how staff responded, and what would have made them feel more at ease or trusting of the practice.
Q09
Long Text
Is there anything else about your recent dental visit — good or bad — you'd like the practice to know?
Q10
Multiple Choice
Which age range do you fall into?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q11
Multiple Choice
What best describes your dental insurance coverage?
- Employer-provided dental insurance
- Individually purchased dental insurance
- Public/government dental coverage
- No dental insurance
- Prefer not to say
Q12
Message
Thank you for sharing your experience! Your feedback goes directly into a report the practice uses to improve patient comfort, communication, and care.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Walks patients through every stage of the visit — booking, wait times, pain management, cost transparency, and trust — not just a single overall rating
- Includes a dedicated question on whether dental anxiety caused patients to delay or skip care, directly tied to an AI follow-up interview that probes the real reasoning behind high or low recommendation scores
- Pairs a MaxDiff exercise on what matters most when choosing a practice with an open-ended long-text question, so quantitative priorities and qualitative context are captured in one flow
- Automatically compiles responses into a report, so practices get analysis-ready findings without manually coding open-ended anxiety and trust comments
Jotform
Dental Patient Experience Survey Form TemplateA ready-to-field dental patient experience form built on Jotform's general form builder. It covers standard experience questions but is a static form rather than a research-tuned instrument with built-in benchmarking logic. Good for quick deployment, less suited to deeper diagnostic analysis of recommendation drivers.
What it does well
- Ready-to-use, no-code form that's easy to deploy quickly
- Backed by Jotform's broad form-building and customization ecosystem
- Likely supports common form fields (ratings, multiple choice) out of the box
Where it falls short
- Static question set with no adaptive follow-up to probe why a patient gave a particular score
- No voice-based interview option for capturing patient sentiment
- No published methodology or per-response quality scoring
QuestionPro
Dental Care Survey TemplateA conventional dental care survey template from a general-purpose survey platform. It likely covers care quality and satisfaction basics but reads as a broad category template rather than one purpose-built around anxiety, trust, and recommendation drivers. Useful as a baseline, but shallow on the psychological 'why' behind scores.
What it does well
- Part of a large template library with enterprise survey features
- Supports standard analytics and dashboarding for aggregate reporting
- Likely offers customizable question types typical of QuestionPro's builder
Where it falls short
- No adaptive AI interviewing to dig into specific low or high recommendation scores
- No dedicated focus on dental anxiety as a driver of care avoidance
- Fixed-form structure without transparent, reviewable AI prompt logic
SurveyMonkey
Patient Satisfaction Survey TemplateA generic post-visit patient satisfaction template, not specific to dental practices. It can be adapted for dental use but lacks any dentistry-specific content around anxiety, cost transparency, or trust in the dentist. Best viewed as a general healthcare satisfaction starting point rather than a dental-tailored instrument.
What it does well
- Backed by SurveyMonkey's established survey distribution and analytics tools
- Generic patient satisfaction framing that's easy to adapt across healthcare settings
- Likely includes standard satisfaction and NPS-style questions
Where it falls short
- Not dental-specific — no questions on dental anxiety, pain management, or dentist trust
- Static question flow with no AI-driven follow-up on individual responses
- No voice interview option or automated per-response quality scoring
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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