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About Us
Services
Technology
Patients
Outreach
Promos
Contact
Book Now

Patient Satisfaction Survey

Thank you for completing this short survey about your most recent visit to our office. Your insights will assist us in improving our services.

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Patient Survey

Survey

WERE YOU TREATED COURTEOUSLY BY THE DOCTOR AT YOUR MOST RECENT VISIT?

Yes

No

WERE YOU TREATED COURTEOUSLY BY THE STAFF?

Yes

No

DID YOU FEEL THAT THE DOCTOR WAS CONCERNED ABOUT YOU?

Yes

No

WAS THE OFFICE ENVIRONMENT CLEAN AND PLEASANT?

Yes

No

WOULD YOU RETURN TO THIS OFFICE FOR MORE TREATMENT?

Yes

No

WAS YOUR EXPERIENCE...

Better than expected

As expected

Less than expected

WOULD YOU REFER THIS OFFICE TO FRIENDS AND FAMILY?

Yes

No

WERE YOU INSTRUCTED ON WHAT TO EXPECT FOLLOWING TREATMENT?

Yes

No

COULD WE HAVE DONE ANYTHING TO MAKE YOUR VISIT MORE PLEASANT?

Yes

No

Please Explain

ADDITIONAL COMMENTS

If you would like to be contacted regarding this survey, please enter your name and phone number:

First Name

Last Name

Phone

Services

Smiles for VETS
Same Day Crowns
Sedation Dentistry

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Office

5111 Clinton Drive
Kokomo, IN 46902
(765) 453-4369

Hours

Mon & Wed: 8am-5pm
Tue & Thu: 8am-6pm
Fri: 8am-1pm

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