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: (optional)

    Email Address*:

    How would you rate your overall visit? ExcellentAdequatePoor

    Were you greeted when you arrived?YesNot ReallyI don't Recall

    Was the Receptionist helpful?YesNot ReallyNot at all

    Were you seen by the dentist in a reasonable amount of time? YesNo

    If you answered no to the above question then how long was the wait?Answered Yes15-30 minutes30-45 minutesOver 45 minutes

    Were your financial options explained to you?YesNoNo, I already understand my financial options

    Did you understand the cost before the treatment was started?YesNot ReallyNot at all

    How was the quality of Care? ExcellentAdequatePoor

    Did your dentist manage your Discomfort? YesNot ReallyI am still in pain

    How was your cleaning? ExcellentAdequatePoor

    Was the Assistant helpful and courteous? YesNot ReallyNot at all

    How would you rate the Cleanliness of our office?ExcellentAdequatePoor

    When your appointment was over, did you have a good understanding of your dental situation?YesNot ReallyI wish I knew more about my situation

    Would you recommend your friends and family to us?YesNoI am not sure

    Please comment on how we can make your visit better.