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Patient Survey
How would you rate your overall visit?
Excellent
Very Good
Average
Not so good
When your appointment was over, did you have a good understanding of your dental situation?
Yes
Not really
I wish I knew more
Were your financial options explained to you?
Yes
No
I already understand my options
Did you have to wait over 15 minutes past your appointment time to be seated?
No
15-20 minutes
20-30 minutes
over 30 minutes
Once seated, did your appointment last the amount of time you expected?
Yes
No
If no, did you understand the reason for the length?
Yes
No
Was the staff courteous and did they greet you properly?
Yes
Not really
I don't recall
Would you refer your friends and family to us?
Yes
No
I'm not sure
If you answer "no" or "I'm not sure" above, please write in a few things to let us know what we can do better.
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.
New Patient Forms
Appointment Request
Patient Survey
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