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* 1. At what time were you seated for your appointment?

* 2. What did you like most about your visit?

* 3. What did you like the least about your visit?

* 4. Did our team members improve your dental knowledge and communicate in a friendly, polite and courteous manner?

* 5. How would you rate the thoroughness of the doctor’s treatment?

* 6. How would you rate the thoroughness of the hygienist’s and assistant's treatment?

* 7. Was your treatment comfortable?

* 8. Did we inform you (prior to treatment) of estimated costs?

* 9. Was your visit to our office a pleasant and positive experience?

* 10. How can we improve our service to you?

* 11. Would you recommend our practice to family and friends?

* 12. Would you like to leave comments with Dr Kitzmiller concerning you treatment?

* 13. This survey is anonymous, but if you would like to speak to Dr Kitzmiller about your visit, please give us your contact information below.

* 14. Thank you for sharing your honest opinions and concerns in this evaluation. Can we improve our survey? Please comment below: