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Patient Survey

On a scale from 1-5, 1 being the lowest and 5 being the highest please rate the following:

 1

 2

 3

 4

 5


 How would you rate the treatment you received today?

 

 

 

 

 

 How do you feel you were treated by the dentist today?

 

 

 

 

 

 How do you feel you were taken care of by the rest of the staff today?

 

 

 

 

 

 How would you rate your overall experience today?

 

 

 

 

 



Would you recommend our office to a friend or family member?   Yes   No

*If you answered Yes, please feel free to ask us for a special Care to Share card which would entitled them to a free consultation, a complimentary benefits check, and an initial exam and X-rays for only $39.00.

*If you answered No, please elaborate so that we may have a better understanding of how we may make improvements in our office and so you may change your mind on referring us.

 

If you have any other suggestions on how we may make your visit with us more comfortable and enjoyable please let us know. Your happiness is important to us and we very much appreciate your feedback.

 

Thank-you,

Dr. DiBona, Dr. Scamardella and Team 

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