To Our Patients: we care deeply about your experience with us. Please let us know your thoughts.

How was the wait time before you were taken in for your appointment?

(1 = bad and 5 = excellent):

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How many minutes was your wait:

Who was your hygienist:

My hygienist was pleasant and friendly:
(1 = bad and 5 = excellent):


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Your overall satisfaction with your hygienist:
(1 = bad and 5 = excellent):


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How do you rate the courtesy of front office staff:
(1 = bad and 5 = excellent):


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My doctor is pleasant and friendly:
(1 = bad and 5 = excellent):


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I would recommend my doctor to others:

Yes 
No 

Your Confidential Comments:

Your Name: (Optional)

Your E-Mail: (Optional)