Patient Survey

We would like your name and email address, so we can respond to your survey, but it isn't required.

Patient Name (Optional)

Email Address (Optional)

How would you rate your overall visit?
Excellent	Very Good	Average	Not so good

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

Were your financial options explained to you?
Yes	No	I already understand my financial options

Did you have to wait over 15 minutes past your appointment time to be seated? If so, how long?
No	15 to 30 minutes	30 to 45 minutes	Over 45 minutes

Did the staff greet you properly?
Yes	No	I don't recall

Would you refer your friends and family to us?
Yes	No	I'm not sure

Please 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.

Press this button to submit your survey. Thank you for taking the time to let us know how your appointment went.