Patient Experience Survey

Name First Last

Email

How would you rate your overall experience? *

Excellent Very Good Average Poor

How informed do you feel about your dental situation? *

I'm an expert, when does med school start? I'm informed, don't bore me with the details. I wish I knew what the clinical team was talking about. What dental situation?

Were your financial options explained to you? *

Yes No I have options? I already understand my financial options.

Did your appointment begin on time? If not, what was the time difference? *

Yes, I was seen on schedule. No, I waited under ten minutes. No, I read half a magazine (about 30 minutes). No, I should have brought my ipod (longer than 30 minutes) I was late...so...um...no, it didn't start on time.

Was the staff friendly and helpful? *

Yes, I felt right at home! (Where's the fridge?) Not really, I felt somewhat lost. I don't remember.

Should Dr. Joe's license plate still say "Painless"? *

Yes, I felt nothing! No, change it to "ouch". Let me see how I feel in the morning. I didn't see the Doctor during my most recent visit.

Would you refer your friends and family to us? *

Definitely Not a chance I haven't decided yet

Please comment to let us know how we can make you feel more comfortable, what we can do better, and what we did well.

Wufoo