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$5 Dental Dollars and win a lunch on me for 4 minutes of your time - Thanks for being a VIP!

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* 1. As a VIP, what has been the best “Perk” in this program for you? (Pinecrestdds.com/vip)

Monthly VIP giveaways & drawings

Extra entries into our big quarterly drawings

1 year of extra savings on dental care for me

Monthly printed newsletters mailed to you

Special gifts/welcome package sent to you

Priority access to our most convenient appointment times, such as evenings, early mornings and Saturdays

Charity participation

Bonus teeth whitening refills or Sonicare toothbrush head refills

Extra tickets to our patient appreciation party

I don’t feel I’ve been informed enough about the Pinecrest Dental VIP program

Bonus savings for my spouse, significant other, or children

Extra entries in the quarterly giveaway drawing

Other (please specify)

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* 2. Which of these would you rate HIGHEST as your choice for an exclusive VIP monthly giveaway? (Pinecrestdds.com/vip)

Golf passes

Lagoon Passes

Deluxe Sonicare Platinum toothbrush kit

Custom teeth whitening

Real Salt Lake Tickets

Ski Passes

Utah Jazz Tickets

Utah or BYU College Football tickets

Smart Watch

USANA Concert Tickets

Hogle Zoo passes

Apple TV

Smart Watch

Amazon.com gift certificate

Grand America overnight stay

Other (please specify)

Question Title

* 3. Which of these would you rate SECOND HIGHEST as your choice for an exclusive VIP monthly giveaway? (Pinecrestdds.com/vip)

Golf passes

Lagoon Passes

Deluxe Sonicare Platinum toothbrush kit

Custom teeth whitening

Real Salt Lake Tickets

Ski Passes

Utah Jazz Tickets

Utah or BYU College Football tickets

Smart Watch

USANA Concert Tickets

Hogle Zoo passes

Apple TV

Smart Watch

Amazon.com gift certificate

Grand America overnight stay

Other (please specify)

Question Title

* 4. In the past or present, which of these is the MOST IMPORTANT reason as to why you’ve avoided or put off regular dental care?

Fear of dental work

Anxiety

Cost

Making time

Lack of insurance

No payment options

Not seeing regular dental visits as important enough

Other (please specify)

Question Title

* 5. In the past or present, which of these is the NEXT IMPORTANT reason as to why you’ve avoided or put off regular dental care?

Fear of dental work

Anxiety

Cost

Making time

Lack of insurance

No payment options

Not seeing regular dental visits as important enough

Other (please specify)

Question Title

* 6. Since you’ve been a patient at Pinecrest Dental, how have we helped you the MOST regarding your dental health?

Enhancing the appearance of your smile

Improved how you feel about the dentist

Helped improve you home hygiene routine

Playing an important role in your overall health maintenance

Susan G. Breast Cancer Awareness

Made your dental visits more comfortable

Other (please specify)

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* 7. What do you feel would be the most valuable referral offer for your friends, family or coworkers when they become a new guest at our practice?

Free consulatation

Movie tickets

Quarterly giveaways (pinecrestdds.com/giveaways)

Dinner

Free copy of Dr. Williams new book, Reason to Smile

Complementary oral sedation

Charity donation

Other (please specify)

Question Title

* 8. Which of these would you choose most as your prize for our quarterly referral giveaway? (Pinecrestdds.com/giveaways)

Deluxe Spa package for 2

Paddleboard

Getaway for 2 to Park City

6 Month Smiles cosmetic braces

Caribbean Cruise for 2

Disneyland Package

Utah Jazz Tickets

Dental implant

Apple Watch

Traeger Grill

Deluxe YETI Cooler

Costco $500 gift card

Other (please specify)

$5 Dental Dollars and win a lunch on me for 4 minutes of your time - Thanks for being a VIP!

Question Title

* 1. As a VIP, what has been the best “Perk” in this program for you? (Pinecrestdds.com/vip)

Question Title

* 2. Which of these would you rate HIGHEST as your choice for an exclusive VIP monthly giveaway? (Pinecrestdds.com/vip)

Question Title

* 3. Which of these would you rate SECOND HIGHEST as your choice for an exclusive VIP monthly giveaway? (Pinecrestdds.com/vip)

Question Title

* 4. In the past or present, which of these is the MOST IMPORTANT reason as to why you’ve avoided or put off regular dental care?

Question Title

* 5. In the past or present, which of these is the NEXT IMPORTANT reason as to why you’ve avoided or put off regular dental care?

Question Title

* 6. Since you’ve been a patient at Pinecrest Dental, how have we helped you the MOST regarding your dental health?

Question Title

* 7. What do you feel would be the most valuable referral offer for your friends, family or coworkers when they become a new guest at our practice?

Question Title

* 8. Which of these would you choose most as your prize for our quarterly referral giveaway? (Pinecrestdds.com/giveaways)

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* 9. Any other comments or suggestions for our VIP program?

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* 10. Your name (required to receive the win a lunch entry and to get your $5 Dental Dollars credit) - your answers will be kept confidential!