This survey is confidential and your candor is appreciated
Strongly Agree
Agree
Unsure
Disagree
1. The office is cheerful and cooperative in making appointments
2. The office appears organized
3. The doctors staff answered my questions satisfactorily
4. The hygienists are gentle and skillfull
5. Do you refer relatives or friends to our office?
Yes
No
If no, why not?
Upon completion of our questionnaire you will receive a parking coupon. Please bring to the office at your next appointment to receive the token redeemable at the parking booth.