Dental Patient Survey

We would like to Thank You for selecting Elegant Smile Dental as your dental practice.
Please let us know how we are doing in the following areas.

Name:       Date of Visit: Pick a date
 
How easy was it to make an appointment by telephone?
  Very Easy
  Easy
  Needs Improvement
 
Were you seated on time for your appointment?
  Yes
  No
  1 to 5 minutes
  5 - 10 minutes
  10 - 15 minutes
  Over 15 minutes
 
Did the staff greet and advise you properly?
  Yes
  Not Really
  No
  I do not remember
 
When your appointment was over, did you have an understanding of
your diagnosis and treatment needed?
  Yes
  Somewhat
  No
  Need to know more
 
Were your billing questions and financial options adequately explained to you?
  Yes
  I already understand
  No
  Need to know more
 
How do you rate our preventive dentistry and hygiene care?
  Excellent
  Good
  Fair
  Needs Improvement
 
How do you rate our restorative and major dental care?
  Excellent
  Good
  Fair
  Needs Improvement
 
 How would you rate your overall visit?
  Excellent
  Very Good
  Average
  Needs Improvement
 
 Will you refer your friends and family to Elegant Smile Dental?
  Definitely, Yes
  Maybe
  No
  I'm not sure yet
 
We appreciate any additional comments or recommendations you have
on individuals, things we could change, new services you would like, or
other ways to make you enjoy your dental experience