PATIENT SURVEY
  
THANKS FOR VISITING!!

We want to know how you would rate your dental experience.
Any suggestions on how we could serve you better,
are always welcome.

What did you have done today?
Cleaning Other
Who was your doctor? 
Hygienist? 
1. Were you satisfied with the treatment you received from the professional staff at our dental office?
   Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied
2. Did the staff listen, understand all of your needs, and answer all your questions?
   Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied
3. Did we begin your appointment ON TIME?  Yes No
4. Were you given POST OPERATIVE INSTRUCTIONS?  Yes No
5. Would you recommend our dental office to a friend, co-worker, or relative?
   Very likely Somewhat likely Neutral Unlikely Very unlikely
6. Why did you choose our dental office?
    A dentist referred you A friend referred you Yellow Pages
    Convenient Hours Convenient location Other  
Comments :
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