We want to know how you feel about your visit to our office. Please take a minute to fill out the information below. We take pride in the quality of our services and we wish to make your visit as comfortable and pleasant as possible.

We’re serious when it comes to patient satisfaction and we will make every reasonable improvement necessary to assure our patients that they can expect a pleasant and comfortable visit. Most people are reluctant to give honest comments. We would greatly appreciate your positive or negative feedback. It is also anonymous. Thanks in advance.
Name *:
Phone *:
Email *:

Please rate each category as it applies to your visit. *

Process of scheduling your appointment

Friendliness of the front desk staff

Comfort of your hygiene visit

Friendliness of your Hygienist

Comfort of your Doctor visit

Friendliness and knowledge of the dental assistant

Checkout process (explanation of copays etc.)

Likelihood of referring your family and friends

Additional comments good or bad are important