How would you rate your overall visit?
Excellent Very Good Average Not Good (please comment below)

Were you greeted in a friendly and respectful manner?
Yes No (please comment below) I don't recall

How long was your wait to be seated?
0-5 mins 5-10 mins 10-20 mins Over 20 mins

If treatment or a cleaning was done, was it a pleasant experience?
Yes No (please comment below) Undecided No treatment was done

When your appointment was over, did you have a good understanding of your dental situation?
Yes No (please comment below) I wish I knew more

Were your financial options explained to you?
Yes No (please comment below) I already understand my financial options

Would you refer your friends and family to us?
Yes No (please comment below) Undecided

Please comment on how we could improve, or what we did well. If you wish to leave your name, please do so:
Comments