Patient Survey Form

How well do you think we did on the following?

What do you think of our website?  
Overall, how was your last visit?  
The dental treatment you received was?  
Do you like listening to music during dental treatment? If so, what type of music do you enjoy listening to?
Do you like the massage chair on during treatment?
Do you like the hot towelettes after dental treatment?
Did you find our team members friendly and helpful? 
How would you evaluate the cleanliness of our office?  

The information and explanation of your

dental condition and treatment options was...
The information about your financial obligations was...
Did you help yourself to Beverages and Snacks at the Welcome Station in our Reception Area?
Have you received information about our Care-to-Share program?

Digital Xrays
Early Detection of Gum Disease
Diode Laser (for painless tissue sculpting)
Invisible Braces
In-office Whitening
Breath odor analysis
Oxyfresh products
Restylane lip enhancement and naso-labial fold filler
 
Did you find our office easily accessible?
Would you recommend us to others?
Other Comments or what would you like to tell us that can improve our service for you?
Optional  
Name
Email Address


 
 

 

 

Disclaimer   Terms of Uses    COPYRIGHT 2006 DENTISTRY21       DESIGNED & DEVELOPED BY DENTISTRY21®

The Cosmetic Dental Center of the Palm Beaches - Thomas Saitta, DDS - Boynton Beach, FL 33426 - Boynton Beach Dentist,
Boynton Beach Cosmetic Dentistry, Boynton Beach Teeth Whitening, Boynton Beach Veneers, Boynton Beach Invisalign,
 Boynton Beach Dental Implants, Boynton Beach Dental Crowns, Boynton Beach Teeth Cleaning, Boynton Beach Root Canals,
Boynton Beach Inlays, Boynton Beach Dentures, Boynton Beach Lumineers, Boynton Beach Gum Surgery, Advance Consulting
Charles S. Kravitz, DDS, Performance Coach, Oxyfresh, CPT, Conservative Periodontal Therapy, Soft Tissue Management