We appreciate you taking the time to complete our survey. Please feel free to comment on our visit as well. Any comments you choose will be kept strictly confidential and can only help us become better in the future

Patient Name:
Email Address:
Please check each item that applies previous, current or future dental treatment.

Appointments	Strongly Agree		Agree		Neutral		Disagree		Strongly Disagree		Not Applicable
It was easy to make an appointment
The appointment secretary was courteous and helpful
Appointment options were given that matched my schedule
Finances & fees were explained to me

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Facilities	Strongly Agree		Agree		Neutral		Disagree		Strongly Disagree		Not Applicable
Office location & parking were convenient
The reception area was neat & clean
The equipment was clean and presentable
The temperature in the office was comfortable

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Staff	Strongly Agree		Agree		Neutral		Disagree		Strongly Disagree		Not Applicable
The dentist was professional and courteous
The dental hygienist was professional and courteous
The dental assistant was professional and courteous
Other staff was professionaland courteous
The staff was considerate and sensitive to my needs

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Treatment	Strongly Agree		Agree		Neutral		Disagree		Strongly Disagree		Not Applicable
The proposed treatment was clearly explained to me
All my questions were answered
Treatment alternatives were given
The dental treatment was completed in a timely and efficient manner
I am pleased with the quality of dental treatment

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