At Advanced 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.
 
 
 1st Visit   Repeat patient (skip to #3) 
1.   Was this your first visit to our office or have you been here before?
2.  If you answered "1st Visit," how did you hear about us?
Other: 
3.  What was the purpose of your visit?
 
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 
4.   Ease of setting your appointment
5.   Greeting by our receptionist when you arrived
6.   Cleanliness/neatness of the waiting room
7.   Cleanliness/neatness of the operatory
8.   Length of time you had to wait before you were called for your appointment
9.   Friendliness of our office staff
10.   Friendliness of the dentist
11.   Quality of the service performed
12.   Degree to which your concerns were addressed by either the technician or the dentist
13.   The ease of checking out and paying after the appointment
14.   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 
15.   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:
16. Name:
17. Phone Number:
18. Email Address: