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Dental patient survey template

Hear how the chair felt, and whether the bill made sense

Four questions for the day of a dental visit: overall satisfaction, comfort, how clearly treatment and costs were explained, and whether patients would recommend the practice. Use it as it is or change any question, and Usertick reads every written answer for you.

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What this dental patient survey tells you

A dental patient satisfaction survey asks about the parts of a visit patients remember: how comfortable they were in the chair, whether the dentist or hygienist explained what they were doing, and whether the cost was clear before the work began. This template keeps it to four questions and about a minute.

It is written for the evening of the visit, sent by Usertick email to the patients seen that day. The same survey runs as a link in your own reminder and follow-up messages, or as a QR code on a card at the front desk.

Results shows overall satisfaction with the share who rated 4 or 5, a heat map of the four parts of the visit, and the NPS score with its trend. Every written answer is read as it arrives and filed under a category such as billing and insurance or staff and communication, with a type and an urgency.

In an emailAs a linkOn your websiteAs a conversation
Questions
4
Time to answer
About a minute
Written for
The evening of the dental visit, by email to the day's patients
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, with the first question inside the email. A tap on an answer opens the rest of the survey with that answer already kept. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 4 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 4 · Stars

Overall, how satisfied are you with your visit today?

Why ask it
One overall rating gives the practice a number to follow from month to month, and it is quick to tap inside the email.
What you learn
The average, a bar per rating and the share who rated 4 or 5, against the period before. Select the low ratings to see which matrix rows those patients scored lowest.
Make it yours
Keep it first, so patients can answer inside the email with one tap and the rest of the survey opens with it kept.
Question 2 of 4 · Matrix · Optional

How would you rate the following?

Why ask it
Four rows cover what makes or breaks a dental visit: comfort, the explanation of treatment, the person who treated them and whether costs were explained beforehand. Each row points to someone who can change it.
What you learn
A heat map per row with row averages, so a low score for explanation of costs stands apart from a high score for comfort.
Make it yours
Split Your hygienist or dentist into two rows when patients see both, so each role gets its own average.
Question 3 of 4 · NPS

How likely are you to recommend our practice to friends or family?

Why ask it
Recommendations from family and friends bring new patients to a practice, so the recommend question tracks how patients are likely to talk about you.
What you learn
The NPS score, promoters at 9 or 10 minus detractors at 0 to 6, with a bar of detractors, passives and promoters, the score per device and the score line over time.
Make it yours
Read the detractors' written answers each week and look for one pattern to fix, such as costs that came as a surprise.
Question 4 of 4 · Text · Optional

Is there anything we could improve?

Why ask it
The open question catches what the matrix doesn't cover, such as reminder calls, parking, the waiting room or the payment plan.
What you learn
Each answer with its sentiment and theme, filterable by theme, with up to 8 themes and their trends. Usertick also marks each one as a complaint, an idea or praise and flags the urgent ones, such as a billing error.
Make it yours
Use the placeholder to ask patients to leave out details of their treatment.

What the answers show

Results turns each question into numbers you can follow week by week.

Overall, how satisfied are you with your visit today?

The average rating and the share who gave 4 or 5 stars, against the period before.

How would you rate the following?

Each row's answers side by side, so the part that needs work stands out.

Every written answer, read for you

Each answer arrives with its category, theme, type and urgency, so the urgent ones reach your team first.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick Dental visit in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Explain costs before the work

    When explanation of costs scores low, give patients a written estimate before treatment starts and watch that row in the next period.

  2. 02

    Send it the evening of the visit

    Send to the day's patients after the last appointment, or schedule the send ahead. Usertick doesn't send on its own when your practice software marks a visit complete.

  3. 03

    Ask again at the next cleaning

    Skip people who already received this survey is on by default. Turn it off when patients who return for their next cleaning should be asked again.

  4. 04

    Call back every detractor

    Give each response scored 0 to 6 an owner and a status in the inbox, and add a note on what was done after the call.

CSAT surveysPatient satisfaction surveysEmail surveysDental care questions

More satisfaction templates and questions

Templates like this one, and single questions from the library to add to it.

Templates

Browse all templates
CSATAppointment experienceLearn how patients experienced a visit, from booking and waiting to how clearly things were explained and what happens next. Send it the same day, and keep it free of medical details.
CSATPharmacy visitLearn how customers rated a pharmacy visit, the wait and how clearly the medicine was explained. Share it on the receipt with a QR code.
CSATPhysical therapy sessionCheck how patients feel after a session and whether their home exercises and treatment plan are clear. Send it an hour after each session.
CSATEmergency visitLearn how patients experienced an emergency visit: waiting, respect, pain management and discharge. Send it two days after discharge.

Questions from the library

Browse the question library
  1. How would you rate your dentist?Stars · Dental care
  2. How long since your last checkup?Dropdown · Dental care
  3. Were you told the cost before the work started?Yes / No · Dental care
  4. How would you rate your hospital stay?Stars · Hospital stay and discharge
  5. Rate the hospital on eachMatrix · Hospital stay and discharge
  6. Did you understand your discharge instructions?Yes / No · Hospital stay and discharge

Frequently asked questions

The evening of the visit, while the chair and the bill are fresh. Usertick sends it now or at a time you schedule up to 30 days ahead.

Four or five. This template asks four and takes about a minute, and the matrix and the last question are optional.

After treatment visits, and after cleanings when those are most of your appointments. Turn off Skip people who already received this survey to ask returning patients again.

Ask them not to. Usertick's terms don't allow health records or medical details in surveys and Usertick doesn't sign business associate agreements, so keep the questions on comfort, the explanation, staff and costs.

Yes, on every plan. A workflow can post every rating of 1 or 2, or every NPS detractor, to Slack or Microsoft Teams, and from Starter also add each response to a Google Sheet.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

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