Patient Name

 

   

How would you rate your overall visit?

     Very Satisfied

 

Satisfied

 

Somewhat Satisfied

 

   

Did the staff treat you professionally on the phone?

Yes
No

 

I do not recall

 

   

Did the staff greet you properly?

Yes

 

No

Comments

 

   

Were the assistants and hygienist's friendly and professional to you and your child?

Yes
No

Comments

 

   

Was the doctor professional and courteous to you and your child?

Yes
No

Comments

 

   

Did cleanliness of our practice meet your expectations?

Yes
No

 

   

Were your financial matters handled in a timely and well addressed manner?

Yes
No
     

Would you refer your friends and family to us?

Yes
No
     

Please comment on how we could make your visit better...

 

 


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Houston Pediatric Dentist - Dr. David Tang. 

Ashford Pediatric Dental Specialists, serving children in he surrounding cities and suburbs of Houston, Texas.

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