When you called to make an appointment, the staff members were courteous and helped find a suitable time.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
Upon arrival, you were greeted in a friendly manner and were put at ease.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
You were seated by your appointment time or advised of any delays.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
The dentist/hygienist listened to and understood your concerns.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
The dentist/hygienist adequately explained the treatment plan and answered your questions.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
You felt that the staff was concerned about your overall well being as a person and not just your dental condition.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
You are comfortable with the level of technology used in the office.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
If you had a concern during your last visit, it was properly handled by the staff.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
You understood the bill for services rendered and any questions were answered to your satisfaction.
Strongly Agree
Agree
Unsure
Disagree
Strongly Disagree
Overall, how do you rate our office?
1 (Lowest)
2
3
4
5 (Highest)
Would you refer a family member or friend to our office?
Yes
No
Did you know that with our Friends & Family Referral Program, both you and your referral can receive a $25 credit for any dental service at Bassett Creek Dental?
Yes
No
Is there anything you would like to change about your smile?
Yes
No
Are you interested in a free cosmetic consultation with a dentist?
Yes
No
Do you have any other comments?
Name (optional)
Preferred contact if you would like a response