Patient Survey

Thank you, for choosing our dental practice to help you maintain good oral health. We appreciate your trust and confidence in us. We are here to render caring, quality dental care, promptly and professionally, in a pleasant and friendly atmosphere. We put our patients first in all we do. We appreciate you taking the time to complete our survey. We aspire to consistently maintain high standards of excellence and patient satisfaction. Your input will help us improve and serve you better. Any comments you make are kept strictly confidential and can only help us become better.


* Doctor's Name:
* Patient Name:
* Email:
How would you rate your overall visit?
Excellent
Adequate
Poor
Were you greeted when you arrived?
Yes
Not Really
I don?t recall
Was the Receptionist helpful?
Yes
Not Really
Not at all
Were you seen by the dentist in a reasonable amount of time?
Yes
No
If you answered no to the above question then how long was the wait?
15-30 minutes
30-45 minutes
Over 45 minutes
Were your financial options explained to you?
Yes
No
No I already understand my financial options
Did you understand the cost before the treatment was started?
Yes
Not really
No
How was the quality of Care?
Excellent
Adequate
Poor
Did your dentist manage your Discomfort?
Yes
Not really
I am still in a lot of pain
How was your cleaning?
Excellent
Adequare
Poor
Was the Assistant helpful and courteous?
Yes
Not really
No
How would you rate the Cleanliness of our office?
Excellent
Adequate
Poor
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
Would you recommend your friends and family to us?
Yes
No
I am not sure
Please comment on how we can make your visit better.
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