How would you rate your overall visit?

Excellent     Satisfactory     Needs Improvement

When your appointment was over did you have a good understanding of your dental situation? 

Excellent     Satisfactory     Needs Improvement

Were your financial options explained to you?

Excellent     Satisfactory     Needs Improvement

Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?

On Time      5-10 Mins         10-15 Mins     15-20 Mins

Did the staff greet you properly? 

Excellent     Satisfactory     Needs Improvement

Would you refer your friends and family to our dental office?

Yes             No

Please rate “Dr. Lee” (Dentist/Owner) 

Excellent     Satisfactory     Needs Improvement

Please rate “Heather” (RDAEF-Front Office) 

Excellent     Satisfactory     Needs Improvement

Please rate “Melissa” (Front Office-RDA) 

Excellent     Satisfactory     Needs Improvement

Please rate “Marina” (Reg. Dental Assist.) 

Excellent     Satisfactory     Needs Improvement

Please rate “Amanda” (Reg. Dental Assist.) 

Excellent     Satisfactory     Needs Improvement

Please rate “Tonya” (Registered Hygienist) 

Excellent     Satisfactory     Needs Improvement

Is there anything we can do to make your dental experience more enjoyable?

 

Tell us what you love most about our dental office.
(remember to leave your name if you would like us to know who completed the survey)

Name: