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Satisfaction Survey
Please enter the information requested and then click on the "Submit" button.
On your last visit you saw?
Doctor
Dentist
Lab
Social Worker
WIC
How do you feel about...
The way you were treated by the staff?
Great
Good
Fair
Poor
Doesn't Apply to my visit
The time it took you to get an appointment?
Great
Good
Fair
Poor
Doesn't Apply to my visit
The time it took you to see the nurse/dental assistant?
Great
Good
Fair
Poor
Doesn't Apply to my visit
The time it took you to see the doctor/dentist?
Great
Good
Fair
Poor
Doesn't Apply to my visit
The amount of time the doctor/dentist spent with you?
Great
Good
Fair
Poor
Doesn't Apply to my visit
The way things were explained to you?
Great
Good
Fair
Poor
Doesn't Apply to my visit
The caring and professional attitude of the staff?
Great
Good
Fair
Poor
Doesn't Apply to my visit
The cleanliness of the clinic?
Great
Good
Fair
Poor
Doesn't Apply to my visit
Who did you see on your last visit?
Give the doctor/dentist's name
Would you recommend this clinic to family and friends?
Yes
No
If no, why?
Was this your first visit to our clinic?
Yes
No
Please leave any other comments you may have
Submit
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