* 1. Upon arrival I was greeted courteously.

* 2. I was seated by my appointment time or advised of any delays

* 3. I feel that I understood the treatment presented and all of my questions were answered to my satisfaction.

* 4. Payment options were discussed and financial arrangements were made for all treatments.

* 5. How satisfied were you with the services you received?

* 6. Please note your overall comfort level in the office.

* 7. I am likely to refer family and friends to this office.

* 8. We are committed to continual improvement in the care we give our patients. Please provide any additional comments that may help us improve our quality of care.