Patient Survey

Were we courteous on the phone?

Yes No

Was our greeting area clean and comfortable?

Yes No

Were you greeted with a friendly smile?

Yes No

Were you seen on time?

Yes No

How would rate your level of comfort during your appointment?
Please rate your comfort level:

How would you rate the value you received in our practice?
Please rate your comfort level:

Were all of your dental questions answered?

Yes No

Were fees discussed in detail prior to your treatment?

Yes No

Would you refer us to a friend or family member?

Yes No

If not, why not?

Any additional information that you would like us to know please fill in below: