To Our Patients

We appreciate you taking the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us become better in the future.

Full Name (optional)


Email Address (optional)

Your Dentist

How would you rate your overall visit when compared to other offices?
Excellent Very Good Average Needs Improvement

What was the date of your visit?

When your appointment was over did you have a good understanding of your dental situation?
Yes Not Really I wish I knew more about my situation

Were your financial options explained to you?
Yes No I already understand my financial options.

Did you have to wait 15 minutes past your appointment time to be seated? If so how long?
No 15-30 minutes 30-45 minutes Over 45 minutes

Did the staff greet you properly?
Yes No I don't recall

Would you refer your friends and family to us?
Yes No Maybe

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.

Phone Number (optional)
( ) -

We would greatly appreciate any additional feedback: