Patient Name

How would you rate your overall visit?

Did the staff treat you professionally on the phone? 		Yes
 No
 I do not recall
 


Did the staff greet you properly?

Comments

 Yes
 No

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

Comments

 
 Yes
 No

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

Comments

 Yes
 No


 

Did the appearance and cleanliness of our office 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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Garland  Pediatric Dentistry ~ Dr. Grace Smart, Garland, TX

Copyright © 2006 Grace E. Smart, D.D.S., M.S.   All Rights Reserved.
Pediatric Dentist serving infants, children and teens in Garland, TX and the surrounding areas.

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