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Survey
Patient Survey
We would appreciate it if you would take the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us serve you and others in the future.
Patient name
Email address
Excellent
Very Good
Average
Not so good
How would you rate your overall visit?
When your appointment was over did you have a good understanding of your dental situation?
Were your financial options explained to you?
If you arrived on time for your appointment, did you have to wait over 15 minutes past your scheduled appointment to be seated? If so how long?
Did the staff greet you properly?
Would you refer your friends and family to us?
Yes
Not really
I wish I knew more about my situation
Yes
No
I already understand my financial options
No
15 to 30 minutes
30 to 45 minutes
Over 45 minutes
Yes
Not really
I don't recall
Yes
No
I'm not sure
Please comment on how we could make your visit better, new services you would like to see, or other ways we might make you feel more comfortable.