Satisfaction Questionnaire

Dear patient,

I am asking you if you would be willing to write a brief report on your experiences surrounding your operation. These patient reports provide us with valuable feedback. Additionally, we would like to place this information on our website, www.drbart.nl, but only if you give us written consent to do so. We wish to do this to provide future patients with better information.

For this purpose, we request that you fill out the questionnaire below. You can send off the form by clicking the 'send form' button on the bottom of the page.

Thank you in advance,
B.F.M.L. van de Ven, specialist in mouth, jaw and facial surgery

1. How do you rate your treatment by the people involved in the operation?

2. What did you think of their professionalism/expertise?

3. Did you suffer a lot of pain and other discomfort, or not at all?

4. Were there any complications, and if so, what were they?

5. Are you satisfied with the final result?

6. Is the outcome what you expected it to be?

7. Would you do it all over again if you had known everything you know now?

8. What can we do to improve our services?

Name
Mr./Mrs.
Mr.Mrs.Ms.
E-mail