Patient Survey [Final]

Patient Survey

In the interest of improving our office and how we serve you, we would appreciate your taking the time to answer the following questions:
Were you greeted in a friendly manner both initially by phone and at your first visit at our office?*

YesNo
Did the consultation visit answer questions/ concerns, and allay anxiety you may have had?*

YesNo
Did you find your oral surgery to be as unpleasant as you originally thought it might be?*

YesNo
Were the postoperative instructions helpful?*

YesNo
Were the financial matters handled in a professional manner?*

YesNo
If there was a need for you to have oral surgery again, would you return to this office?*

YesNo
How could we improve the service we render to our patients?
Name of referring dentist or physician:
Would you like a staff member to call you regarding any of the above concerns?*

YesNo
Thank you for your time and suggestions!
Patient Name:*
Surgeon:

DR. HABIJANACDR. SMITHDR. COBBDR. FISHERDR. ROULEAUDR. BUI
Should be Empty:

Patient Survey