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.

Name (optional)
Phone Number (optional)
E-mail Address (optional)
How would you rate your overall visit? Excellent Very Good Average Poor
Did you wait over 15 minutes past your appointed time? If so, how long? No 15 to 30 minutes 30 to 45 minutes Over 45 minutes
Did the staff greet you properly? Yes Not really I don’t recall
Were your financial options discussed with you? Yes No I already understand my financial options
Did you leave with a good understanding of your dental situation? Yes No, I wish I knew more about my situation
Would you refer your friends and family to us? Yes No I’m not sure
Please use the area to the right to 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.
Would you like us to contact you regarding your survey feedback? No Yes (contact information provided above)