Here at our practice, we are dedicated to providing you with the best dental care and service possible. You can help us meet our goals in the endeavor by taking this short survey. Thank you in advance.

1. On the scale of 1 to 10 (1 = dissatisfied 10 = satisfied) how would you rank your visit:

2. What did you like best about your visit:

3. What did you like least:

4. If we should change or work to improve any part of our care or service, what should it be?

Additional Comments:

Name (optional)

Date of visit (optional)