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* 1. Please enter your name. (optional)

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* 2. How was your dental visit today?

  Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree
I was able to get an appointment on a timely basis.
I was greeted warmly upon arrival.
The Doctor was courteous and attentive.
The Dental Assistant/Hygienist was courteous and attentive.
My treatment needs and options were adequately explained.
Insurance and fees were satisfactorily explained.
My treatment was gentle. I am comfortable in your office
My questions were answered

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* 3. Would you be comfortable referring others to our office?

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* 4. Anything else you would like to share about your visit?

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