Patient Satisfaction Survey

How do you feel about your experience in our office?

Excellent Average Not so good

Did you receive a warm and friendly greeting from the staff when you entered our office?

Always Usually Rarely Never

When you call to make your appointment, is the person answering your call polite, courteous and helpful?

Always Usually Rarely Never

Does the dentist and assistants take the right amount of time to explain your treatment and answer your questions?

Always Usually Rarely Never

When you visit our office, how long do you usually have to wait (after your scheduled appointment time) before your child is seen?

Little or no time 5 minutes 10 minutes Longer than 10 minutes

How do you feel about the professionalism of our staff?

Very professional Average Not professional

Were your financial options explained to you in detail and in a way that allowed you complete understanding?

Yes No I already understand my financial options

Would you refer your friends and family members to us for their dental care?

Yes No Not sure

Please comment on how we can make your visit with us better and ways we can make you feel more comfortable.

(Optional) Please provide us with your name and email address.