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Forms
Discrimination questionnaire
Doctor's Fullname
Evaluate the following types of tasks from 1-5, where: 1 not at all satisfied, 5 a lot satisfied.
A) Immovable prosthetics
Metal-ceramic restorations
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Implant restorations
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Zirconium restorations
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
All-ceramic restorations e.max
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Bio HPP
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
B) Mobile prosthetics
Implant restorations
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Zirconium restorations
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
All-ceramic restorations e.max
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Bio HPP
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Partial denture
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Dentures
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Thermoplastic partial denture
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Closing splints
Expertise
1
2
3
4
5
Aesthetics
1
2
3
4
5
Application - Closing
1
2
3
4
5
Cost
1
2
3
4
5
Evaluate our services
Ease of communication
1
2
3
4
5
1: Not at all satisfied /5: very satisfied
Problem Solving - Complaints
1
2
3
4
5
1: Not at all satisfied /5: very satisfied
Consistency
1
2
3
4
5
1: Not at all satisfied /5: very satisfied
Fiscal policy
1
2
3
4
5
1: Not at all satisfied /5: very satisfied
Modern techniques / Technological equipment
1
2
3
4
5
1: Not at all satisfied /5: very satisfied
Adequate information from the laboratory on new technologies and materials
1
2
3
4
5
1: Not at all satisfied /5: very satisfied
Prioritize the following services (where 1: important, 5: less important), based on the needs and requirements of your practice.
Ease of communication
1
2
3
4
5
Problem Solving - Complaints
1
2
3
4
5
Consistency
1
2
3
4
5
Fiscal policy
1
2
3
4
5
Modern techniques / Technological equipment
1
2
3
4
5
Are there any remarks that would help us get closer to your expectations?
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