FEEDBACK

Full Name (optional)

Email Address (optional)

Your Dentist

How would you rate your overall visit when compared to other offices?
How would you rate your overall visit when compared to other offices?ExcellentVery GoodAverageNeeds Improvement

What was the date of your visit?

When your appointment was over did you have a good understanding of your dental situation?
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?
Were your financial options explained to you? YesNoI already understood my financial options

Did you have to wait 15 minutes past your appointment time to be seated? If so how long?
Did you have to wait 15 minutes past your appointment time to be seated? If so how long? No15-30 Minutes30-45 MinutesOver 45 Minutes

Did the staff greet you properly?
Did the staff greet you properly? YesNoI Don't Recall

Would you refer your friends and family to us?
Would you refer your friends and family to us? YesNoMaybe

Phone Number (optional)


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. If you would like us to contact you about your comments please leave us your number.

We would greatly appreciate any additional feedback:
Comments