This printable dental patient satisfaction survey helps dental practices collect honest feedback from every patient across 9 questions, including those who never open an email or online portal. The form prints on a single sheet and takes about two minutes to complete.
What this survey measures
The rating grid covers the parts of a dental visit that shape how patients feel about your practice: how easy it was to book, waiting time on the day, the hygienist, communication from the dentist, comfort and pain management, value for money, and the cleanliness of the practice. A likelihood-to-recommend question gives you a simple score to track over time, and an open comment box captures anything the fixed questions miss.
How to use it on paper
Hand the survey to patients at checkout or leave copies in the waiting room with a drop box at reception. Patients fill the checkboxes with a blue or black pen. Collect the completed forms and scan them in batches: PaperSurvey reads the checkbox answers with optical mark recognition and converts the handwritten comments to text automatically, so results appear in your dashboard without any manual data entry.
Customize this template
Add your practice logo, reword the grid rows to match your services, or add questions about specific treatments and providers. The paper layout reflows automatically as you edit, and every copy you print stays scannable.
Preview the PDF above, or use this template to start collecting patient feedback today.