Patient Survey

We appreciate you taking 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 become better in the future.

Patient Name (required)

Email Address (required)

How would you rate your overall visit?
Excellent 
Very Good 
Average 
Not so good 

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 situation

Were your financial options explained to you?
 Yes

 No
 I already understand my financial options

Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?
 No
 15 to 30 minutes
 30 to 45 minutes
 Over 45 minutes

Did the staff greet you properly?
 Yes
 No
 I don't recall

Would you refer your friends and family to us?
 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 can make you feel more comfortable