PATIENT SURVEY
	At Paradise Dental, we strive to offer the very best in patient care. In order to provide that care we turn to our patients for advice. Please take a moment to complete the patient survey below. We thank you in advance for your time and participation. The information below is confidential, and will only be used to improve our service.
	1.   What was the purpose of your visit? Cleaning , exam, x-rays Restorative Dentistry Emergency Dentistry Consultation   On a scale of 1 to 5, with 5 being "Great," how would you rate your experience on your last visit? If a particular line does not apply to your visit, please skip it.  Poor   Fair   Okay   Good   Great  2.   Ease of setting your appointment 3.   Cleanliness/neatness of the waiting room 4.   Cleanliness/neatness of the operatory 5.   Length of time you had to wait before you were called for your appointment 6.   Friendliness of our office staff 7.   Friendliness of the dentist 8.   Quality of the service performed 9.   Degree to which your concerns were addressed by either the technician or the dentist 10.   The ease of checking out and paying after the appointment 11.   In your own words, let us know any issues or concerns you may have about our services or office practices and procedures.    Poor   Fair   Okay   Good   Great  12.   How likely is it that you would recommend our dental office to your family members, co-workers, and friends?   If you would like to provide us with your contact information please use the boxes below: 13.   Name: 14.   Phone Number: 15.   Email Address: