Satisfaction Survey

Patient Name

Overall, on a scale from 1-10, how would you rate our office?

Is there some way we can change our office that would make your visits more enjoyable?

Did you wait an excess amount of time before being seen?

Were finances explained and your fees exactly as you expected?

Do you feel knowledgeable on your dental treatment plan?

Were you treated courteously throughout the office?

Based on your experiences, would you refer friends and family to us?

Is there a staff member you'd like to comment on?

Your additional comments only make us aware of areas we need to improve or areas we exceed in: