Patient Name

(Optional)

   

How would you rate your overall visit?

Very Satisfied
  Satisfied

 

Somewhat Satisfied

 

   

Did the staff treat you professionally on the phone?

Yes
No

 

I do not recall

 

   

Did the staff greet you properly?

Yes

 

No

Comments

 

   

Were the assistants and hygienist's friendly and professional to you and your child?

Yes
No
Comments

 

   

Was the doctor professional and courteous to you and your child?

Yes
No

Comments

 

   

Did cleanliness of our practice meet your expectations?

Yes
No

 

   
Were your financial matters handled in a timely and well addressed manner? Yes
No
     
Would you refer your friends and family to us? Yes
No
     
Please comment on how we could make your visit better...

   
Please feel free to share positive comments here

 

   
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Pediatric Dentist serving infants, children and teens in Highlands Ranch, CO
and the surrounding  areas of Centennial, Parker, Lone Tree and Littleton, CO

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