Customer Satisfaction Survey - Custom Smiles Dental Laboratory

Name

First

Last

Office Name

Account Number

How long have you been a customer?

Which of our products have you used?

Fixed
Removables
Orthodontics
Other

Please let us know which products you've used

Did you consider similar products during your research prior to purchasing?

Yes
No

Which similar products did you consider?

How satisfied are you with our

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Fixed Services	Very UnsatisfiedFixed Services Very Unsatisfied	UnsatisfiedFixed Services Unsatisfied	NeutralFixed Services Neutral	SatisfiedFixed Services Satisfied	Very SatisfiedFixed Services Very Satisfied
Removables Services	Very UnsatisfiedRemovables Services Very Unsatisfied	UnsatisfiedRemovables Services Unsatisfied	NeutralRemovables Services Neutral	SatisfiedRemovables Services Satisfied	Very SatisfiedRemovables Services Very Satisfied
Orthodontics Services	Very UnsatisfiedOrthodontics Services Very Unsatisfied	UnsatisfiedOrthodontics Services Unsatisfied	NeutralOrthodontics Services Neutral	SatisfiedOrthodontics Services Satisfied	Very SatisfiedOrthodontics Services Very Satisfied
Turnaround Times	Very UnsatisfiedTurnaround Times Very Unsatisfied	UnsatisfiedTurnaround Times Unsatisfied	NeutralTurnaround Times Neutral	SatisfiedTurnaround Times Satisfied	Very SatisfiedTurnaround Times Very Satisfied
Quality and Accuracy	Very UnsatisfiedQuality and Accuracy Very Unsatisfied	UnsatisfiedQuality and Accuracy Unsatisfied	NeutralQuality and Accuracy Neutral	SatisfiedQuality and Accuracy Satisfied	Very SatisfiedQuality and Accuracy Very Satisfied
Communication & Responsiveness	Very UnsatisfiedCommunication & Responsiveness Very Unsatisfied	UnsatisfiedCommunication & Responsiveness Unsatisfied	NeutralCommunication & Responsiveness Neutral	SatisfiedCommunication & Responsiveness Satisfied	Very SatisfiedCommunication & Responsiveness Very Satisfied
Overall Lab Services	Very UnsatisfiedOverall Lab Services Very Unsatisfied	UnsatisfiedOverall Lab Services Unsatisfied	NeutralOverall Lab Services Neutral	SatisfiedOverall Lab Services Satisfied	Very SatisfiedOverall Lab Services Very Satisfied
Billing	Very UnsatisfiedBilling Very Unsatisfied	UnsatisfiedBilling Unsatisfied	NeutralBilling Neutral	SatisfiedBilling Satisfied	Very SatisfiedBilling Very Satisfied

Have you needed to contact customer service?

Yes
No

of to Name

Please rate your satisfaction with

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Wait time	Very UnsatisfiedWait time Very Unsatisfied	UnsatisfiedWait time Unsatisfied	NeutralWait time Neutral	SatisfiedWait time Satisfied	Very SatisfiedWait time Very Satisfied
Support staff knowledge	Very UnsatisfiedSupport staff knowledge Very Unsatisfied	UnsatisfiedSupport staff knowledge Unsatisfied	NeutralSupport staff knowledge Neutral	SatisfiedSupport staff knowledge Satisfied	Very SatisfiedSupport staff knowledge Very Satisfied
Response received	Very UnsatisfiedResponse received Very Unsatisfied	UnsatisfiedResponse received Unsatisfied	NeutralResponse received Neutral	SatisfiedResponse received Satisfied	Very SatisfiedResponse received Very Satisfied

How likely are you to

	Very Unlikely	Unlikely	Neutral	Likely	Very Likely
Buy from us again	Very UnlikelyBuy from us again Very Unlikely	UnlikelyBuy from us again Unlikely	NeutralBuy from us again Neutral	LikelyBuy from us again Likely	Very LikelyBuy from us again Very Likely
Endorse our product	Very UnlikelyEndorse our product Very Unlikely	UnlikelyEndorse our product Unlikely	NeutralEndorse our product Neutral	LikelyEndorse our product Likely	Very LikelyEndorse our product Very Likely
Endorse our company	Very UnlikelyEndorse our company Very Unlikely	UnlikelyEndorse our company Unlikely	NeutralEndorse our company Neutral	LikelyEndorse our company Likely	Very LikelyEndorse our company Very Likely

Additional comments or suggestions