Thank you for choosing us as your dental practice. We welcome your suggestions to help us improve our care to you. Please complete the following information by selecting the most appropriate answer.

Patient Name:

1. Did we make you feel welcome and serve you in a friendly manner?

Yes. No.

2. Did the team meet you properly?

Yes. Not really. I don't recall.

3. Were your financial options explained to you?

Yes. No. I was already aware of my financial options.

4. When your appointment was over did you have a good understanding of your dental situation?

Yes. Not really. I wish I knew more about my treatment.

5. Did you have to wait past your appointment time to be seated? If so, how long?

No. 15 to 30 min. 30 to 45 min. Over 45 min.

6. How would you rate you overall visit?

Excellent. Very good. Average. Not so good.

7. Would you refer our office to a friend or family member?

Yes. No. I'm not sure.

8. Please comment on anyone you met during your visit, things we could change, new services you would like to see, or ways we can make you feel more comfortable.

Verification Code (case sensitive):

Thank you for sharing your comments with us!