Exit

Sorry to see you go! In an effort to serve you better, I have prepared a brief survey for you. We GREATLY appreciate your feedback! (We’ll Send you a $5 gift card just for sharing your thoughts!)

Question Title

* 1. What is the reason(s) you don’t plan to return to our office? (Select all that apply)

The Service didn’t meet my expectations

No one from your office has followed up with me

I don't have insurance

I don't have a Pinecrest Membership Plan

I'm too busy right now

I don't feel I have a need for dental care right now

I'm nervous or anxious about dental care

I have limited access to transportation

I don’t qualify for financing

My experience was uncomfortable

Bad timing

Other (please specify)

Question Title

* 2. How responsive have we been to your questions or treatment options?

Extremely responsive

Very responsive

Somewhat responsive

Not so responsive

Not at all responsive

Not applicable

Question Title

* 3. Which of the following words would you use to describe the service(s) we provide? Select all that apply.

Reliable

High quality

Useful

Unique

Good value for money

Multiple payment options

Impractical

Ineffective

Poor quality

Low Value

Unreliable

Other (please specify)

Question Title

* 4. Overall, how satisfied are you with the service you've received at Pinecrest Dental?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Other (please specify)

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* 5. How well do our oral health services meet your needs?

Extremely well

Very well

Somewhat well

Not so well

Not at all well

Other (please specify)

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* 6. How likely is it that you would recommend Pinecrest Dental to a friend or colleague?

Not at all likely

Extremely likely

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* 7. How well do our comfort amenities make you visits as enjoyable as possible (you know, for being a "dentist," how well do we make you feel welcome, safe and comfortable)?

Extremely well

Very well

Somewhat well

Not so well

Not at all well

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* 8. Please share why you don’t plan to return in your own words

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* 9. For our next charity, which organization would you prefer we make a donation to?

Salt Lake Donated Dental Services

The Oral Cancer Foundation

Breast Cancer Awareness

The VA Hospital

Horizon Elementary

Other (please specify)

Question Title

* 1. What is the reason(s) you don’t plan to return to our office? (Select all that apply)

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* 2. How responsive have we been to your questions or treatment options?

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* 3. Which of the following words would you use to describe the service(s) we provide? Select all that apply.

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* 4. Overall, how satisfied are you with the service you've received at Pinecrest Dental?

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* 5. How well do our oral health services meet your needs?

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* 6. How likely is it that you would recommend Pinecrest Dental to a friend or colleague?

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* 7. How well do our comfort amenities make you visits as enjoyable as possible (you know, for being a "dentist," how well do we make you feel welcome, safe and comfortable)?

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* 8. Please share why you don’t plan to return in your own words

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* 9. For our next charity, which organization would you prefer we make a donation to?

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* 10. Your name (optional) - will be kept confidential