Dental appointment request form
Patients request a check-up or treatment with their reason for visit, preferred day and time of day.
Patient satisfaction survey
Patients notice waiting times, rushed explanations and an unfriendly reception long before they notice anything clinical, and they rarely say so in person. This survey asks about exactly those points: an overall star rating, how long they waited, whether things were explained clearly, how the team came across and whether they'd recommend you. The name is optional, and the comment field asks patients not to include health details, so the survey stays about your service.
Opens as an editable form in your dashboard. If you're not signed in yet, you'll sign in or create an account first.
This template is a starting point, not legal advice. Check the questions, the consent text and how long you keep the answers against the data protection rules that apply to your practice.
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What's in this template
Every field can be renamed, reordered, made optional or removed in the form builder.
- What was your visit for?Dropdown · Optional
- How satisfied were you with your visit overall?Star rating · Required
- How long did you wait after your appointment time?Single choice · Optional
- Was everything explained clearly?Single choice · Optional
- How friendly was the team?Star rating · Optional
- Would you recommend us to friends or family?Single choice · Optional
- What could we do better? (optional)Long answer · Optional
- Your name (optional)Short answer · Optional
- ConsentCheckbox · Required
How to use this template
Open it in your dashboardSelect “Use this template”. If you don't have an account yet, sign up first; the form opens right after.
Make it yoursChange the questions, options, colours and the thank-you message in the form builder, then save.
Share it and get submissionsShare the form's link or link to it from your website. Each submission is emailed to you and saved in your dashboard.
Tips for this form
- Send the survey the day after the visit, while the experience is fresh, for example with a link in your follow-up message.
- Look at waiting times by weekday to see which session needs more room in the schedule.
- Keep the survey short; patients answer six quick questions more readily than a long questionnaire.
- Share the results with your team every month, and tell patients in the description what you changed because of their feedback.
Running a business like this? See how Zotview sets up the website, booking and forms for Clinics and practices.
Zotview for Clinics and practicesQuestions about this template
Can patients answer anonymously?
Yes. The name field is optional. If you send the link by email, keep in mind that the email address itself is not part of this form unless you add it.
Why does the comment field say not to include health details?
The survey is about your service, not about the treatment. Asking patients to leave out health details keeps sensitive data out of a form that doesn't need it.
Can I use the results in public reviews?
Not without asking. The survey's consent covers improving your service. If you'd like to publish a quote, use a testimonial request form that asks for permission explicitly.
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Zotview form builder
Start with this form, change anything later
The template opens in the form builder, where you can edit every question and choose who receives the submissions.