Patient Survey

Name*

Phone*

Email*

What procedure did you have done?*

How would you rate your overall visit?*

When your appointment was over did you have a good understanding of your dental situation?*

Were your financial options explained to you?*

Did you wait over 15 minutes past your appointment time to be seated? If yes, how long?*

Did the staff greet you promptly?*

Would you refer your friends and family to us?*

What, if any improvements could we make to improve your next visit?

Any other comments/concerns regarding your visit?