Patient Survey
Please take a moment to share your feeling about your recent experience in our office and mail it back to us in the envelope provided. Your opinions help us continue to improve the quality of care we strive to provide to our patients,as well as make us aware of any areas that need to be improved.
1. If you called to schedule your appointment, was your call handled in a courteous, professional manner?____________________ Who did you speak with? Sarah Tonia Mila Tammy Not sure
2. Did you receive a courtesy call from our office to confirm your appointment?________________
3. If you called the office with a question or concern, was it addressed promptly and courteously?________ Who did you speak with? Sarah Tonia Mila Tammy Not sure
4. When you arrived, How long did you wait in front of the window before you were greeted by a staff member?_____________________
5. How would you rate your office visit today? Please rate from 1-10 ____________________
6. Who was your dental assistant today? Chelsey Tammy Amy Peter Anganette
7. How would you rate his/her care today? Please rate from 1-10 _____________________
8. Which dentist did you see today? Dr. Szott Dr. Zaman Not sure
9. How would you rate his care today? Please rate from 1-10 ________________________
10. How would you rate your hygienist if seen today? __________________________________
11. Would you recommend this dentist to a family or friend or coworker? ______________________
12. Please rate the overall appearance and comfort of our facility. Please rate from 1-10 ____________
13. Please rate the friendliness and professionalism of our doctors and staff..Please rate from 1-10 _________
Please feel free to share any other comments or concerns:
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1. Your name(optional) ________________________________________ Date:____________________
2. We appreciate you taking the time to complete this survey. Thank you !