Oceanfront Dentistry
Get the Flash Player to see this player.
Home Our Doctors Our Staff Services Gallery Resources Testimonies FAQ Financial Options Contact
Patient Forms
Survey
Current Events

Start Smiling More
Problems with Snoring?
Interested in Whitening your Smile?

Survey

Please complete the following form and click Submit

 

The office is conveniently located.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The waiting room is comfortable and attractive.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The office is always clean.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The staff is well groomed.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The doctor and staff are always courteous.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
I am always greeted by someone when I enter the office.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
Incoming phone calls are answered promptly.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The doctor and staff answer all my questions satisfactorily.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The doctor and staff show a genuine interest in their patients.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The receptionist is cheerful and cooperative in making appointments.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The doctor and staff appear to get along with each other.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The doctor and staff are skillful in performing their tasks.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
I believe I am (my child is) receiving excellent care.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
The practice appears organized.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
I am normally seen on time.
Strongly Agree    Agree    Neither agree nor disagree    Disagree   
What do you like best about this office?
What do you like least about this office?
Would you refer any of your friends to our office?
Yes    No   
Have you referred anyone to our office?
Yes    No   
Additional Comments:

Home Our Doctors Our Staff Services Gallery Resources Testimonies FAQ Financial Options Contact

Site Created & Maintained by Bull & Company MediaWorks