Customer Satisfaction Survey


We appreciate you as a patient and want to make our office the best we can. Thanks for taking a few minutes to give us feedback on what is important to you!

We appreciate you choosing us as your dental care provider. What brought you here?

Why did you originally choose our practice for your dental care?

When I called the office, the person who answered was:

When I arrived (please select all that apply):

The next few questions will help us make each visit to our office the best possible experience for you!

Which doctor and/or hygienist did you see today?

The office and treatment rooms were:

The hygienist (please select all that apply):

The doctor (please select all that apply):

The doctors and this office (please select all that apply):

The technology and techniques in this office are:

We're looking to expand our knowledge and skills to better meet your needs. Please select from the following all the services that you would like to s

Would you recommend this office to a friend?

We offer a wide range of dental services in our office. Please select any of the following you were not aware we provide:

Some things about your office I really enjoy are:

However, some areas you could improve on are:

Thanks! Your candid feedback is greatly appreciated. We hope to continue to shape our practice and team to better serve your dental needs.