Patient Feedback

We appreciate you taking the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us become better in the future.

*Patient name

*Email address

Date of last visit

The front desk staff gave me a warm greeting upon my arrival:

Strongly Agree----------------------------------------------------------------Strongly Disagree

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I was brought back for my appointment on time:

Strongly Agree----------------------------------------------------------------Strongly Disagree

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The doctor and staff took the time to explain all of my treatment options:

Strongly Agree----------------------------------------------------------------Strongly Disagree

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My appointment was comfortable and pain-free:

Strongly Agree----------------------------------------------------------------Strongly Disagree

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The staff was respectful and professional:

Strongly Agree----------------------------------------------------------------Strongly Disagree

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The doctor and staff answered all my questions to my satisfaction:

Strongly Agree----------------------------------------------------------------Strongly Disagree

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My financial options were explained to my satisfaction:

Strongly Agree----------------------------------------------------------------Strongly Disagree

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Overall, my experience at Summit Dental was:

Fantastic
Good
Average
Poor
Terrible

I would refer my friends and family to Summit Dental:

Absolutely
Probably
I'm not sure
Probably not
Absolutely not

Is there anything else you would like to tell us about your experience at Summit Dental?

Please review the information you are about to submit for accuracy. Thank you!

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