Patient Survey

We are constantly striving to provide better treatment and care for our patients. We would like to know how you perceive our services. Please take a few minutes to complete this Patient Survey Questionnaire. Your responses are anonymous and will be used to better the office. Your cooperation is greatly appreciated.

Patient Name
How would you rate your overall visit?	Very Satisfied Satisfied Somewhat Satisfied
Did the staff treat you professionally on the phone?	Yes No I do not recall
Did the staff greet you properly?	Yes No
Comments
Were the assistants and hygienists friendly and professional to your child?	Yes No
Comments
Was the doctor professional and courteous to you and your child?	Yes No
Comments
Did cleanliness of our practice meet your expectations?	Yes No
Were your financial matters handled in a timely and well addressed manner?	Yes No
Would you refer your friends and family to us?	Yes No
Please comment on how we could make your visit better
Please feel free to share positive comments here
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