Family Satisfaction Questionnaire - National Maternal and Child Oral ...

Family Satisfaction QuestionnaireWe would like to know how satisfied you were with your child’s appointment today. Please answer the followingquestions to help us provide the best care that we can. You do not need to give us your name. Thank you.1. What did you expect for your child’s appointment today and what was actually done?ExpectedActually doneAn examination No Yes No YesX-rays No Yes No YesTeeth cleaning No Yes No YesOther preventive procedures No Yes No YesDental fillings No Yes No YesExtractions No Yes No YesCounseling about home oral hygiene care No Yes No YesReferral to a specialist No Yes No YesDon’t know No Yes No YesOther No Yes No YesComments: