Fill out Our 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 about my situation

Were your financial options explained to you?

Yes

No

I already understand my financial options

Did you have to wait over 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

Not really

I don't recall

Would you refer your friends and family to us?

Yes

No

I'm not sure

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.
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Preferred day of the week

  

MON

TUE

WED

THU

FRI

Preferred time of day

  

A.M.

P.M.

  

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