Survey | Freeman Pediatric Dentistry

Name:

Email:

How satisfied were you with your initial phone conversation?

Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied

Were you warmly greeted when you entered our office?

Yes
No

Were the registration forms easy to understand and complete?

Yes
No

How satisfied were you with the office environment?

Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied

Did the doctor listen carefully to your concerns?

Yes
No

If your child needed treatment, did you understand what treatment was needed and why your child needed treatment?

Yes
No
Not Applicable

During checkout, were all your financial and insurance questions answered?

Yes
No

If a friend were looking for a dentist, would you feel comfortable in recommending our practice?

Yes
No

What are the things that you like about our office?

What could we do to improve our practice?

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