Patient Survey

This survey is an anonymous form to provide us with information on your experience. This helps us continue to improve our services for you and your loved ones. Your input is very important to us!

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?