Patient Name (Optional):
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
Yes No I already understand my financial options
Did you have to wait past your appointment time to be seated? If so, how long?
No 15 to 30 minutes 30 to 45 minutes Over 45 minutes
Did our team 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...
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