Patient Survey

How would you rate your overall visit?

Excellent
Very good
Average
Not good

When your appointment was over did you have a good understanding of your dental situation?

Yes
No
I wish I knew more about my situation

Were your financial options explained to you?

Yes
No
I already understand my financial options

Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?

No
15 to 30 minutes
30 to 45 minutes
Over 45 minutes

Did the staff greet you properly?

Yes
No
I do not recall

Would you refer your friends and family to us?

Yes
No
I am not sure

Your Name

Email Address

Message

Emmert Dental