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Patient Survey

Patient Survey

Patient Name (required):

Email Address (required):

How would you rate your overall visit?
ExcellentVery GoodAverageNot so good

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

Were your financial options explained to you?
YesNoI already understand my financial options

Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?
No15 to 30 minutes30 to 45 minutesOver 45 minutes

Did the team greet you properly?
YesNot reallyI don't recall

Would you refer your friends and family to us?
YesNoI'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.