Patient Survey

 

Patient Survey

Patient Name (Optional):

How would you rate your overall visit?

 
 
 

Did the staff treat you professionally on the phone?

 
 
 

Did the staff greet you properly?

 

Comments

Were the assistants and hygienist's friendly and professional to you and your child?

 

Comments

Was the doctor professional and courteous to you and your child?

 

Comments 

Did cleanliness of our practice meet your expectations?

 

Were your financial matters handled in a timely and well addressed manner?

 

Would you refer your friends and family to us?

 

Please comment on how we could make your visit better...

Please type "123" in the box below to validate your submission.