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SCIENCE OF TEETH WHITENING
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INVISALIGN
SEDATION DENTISTRY
SMILE GALLERY
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PATIENT SURVEY
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YOUR THOUGHTS
We appreciate your taking the time to complete our survey.
Our practice values happy, satisfied patients.
Our success is based on our patients’ recommendations.
Online Survey
Patient name:
Patient phone number:
Patient e-mail address:
1. Were you pleased with your overall experience with us?
Excellent
Very Good
Average
Below Average
2. Did our doctor(s) and team listen and fully explain treatment options?
Excellent
Very Good
Average
Below Average
3. Please rate how important we made you feel.
Excellent
Very Good
Average
Below Average
4. How well did we respect your time?
Excellent
Very Good
Average
Below Average
5. Were your financial options explained and handled well?
Yes
No
6. Are there any areas in which our service could be improved?
Yes
No
Comments:
phone: 913.345.2929 Protect & Enhance All your Smile Needs at One Location!