How would you rate your overall visit? Excellent Good Neutral Adequate Poor
Was the receptionist helpful? Yes Not Really Not At All I Don't Recall
Were you seen by the dentist in a reasonable amount of time? Yes No
If no, how long was the wait? 5-10 Minutes 10-15 Minutes 15-25 Minutes 25-35 Minutes 35+ Minutes
Were your financial options explained to you? Yes No Not Applicable - I already understand my financial options
Did you understand the cost before the treatment was started? Yes No
Did your dentist manage your discomfort? Yes No I am still in pain
How was your cleaning? Excellent Adequate Poor
Was the assistant helpful and courteous? Yes No Not Applicable
How would you rate the cleanliness of our office? Excellent Adequate Poor
When your appointment was over, did you have a good understanding of your dental situation? Yes No I would like to know more information
Would you recommend your friends and family to us? Yes No I'm not sure
Please comment on how we can make your visit better. (Optional)
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