Patient Survey

Welcome to our Patient Survey. Your feedback is very important to us! Please take a moment to fill out our patient survey.
Your name, phone number, and email are not required if you would like to submit the survey anonymously.

Name:
Phone:
Email:

Were you referred to our practice?


When you contacted our office to make an appointment, were our team members courteous and helpful in finding a suitable time?

When arriving at our office, were you greeted in a friendly manner?

Were you seated by your appointment time or notified of any delays there may be?

Did our team members listen and understand your concerns?

Did our team members take the time to thoroughly explain your treatment plan and answer any questions you may have had?

Did our team members discuss your payment options in order to make your dental treatment more affordable and manageable for you?

During your visit, did you feel that our office met your expectations as far as cleanliness?

Overall, how would you rate your visit at our clinic? (1 being the worst and 10 being the best)

Would you recommend our practice to your family and friends?

If you answered YES or NO to any of the above questions and want to explain further please use the space below.

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