PATIENT COMMENT CARD
Thank you for taking a moment provide your feedback!
Which office did you visit?
Date and Time:
Who was your dentist?
How were you treated by the staff and dentist?
Why did you come into the office?
Exam & Cleaning
If you received an injection & your mouth was numbed, did the dentist follow up within 24 hrs?
If you’re a NEW patient, did you receive a welcome note in the mail after your visit?
How would you rate your overall experience?
If we need to contact you, please provide your name, and email address or phone number below:
Content on this page requires a newer version of Adobe Flash Player.