Patient Survey

We appreciate you taking the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us become better in the future. You may also call us with your feedback - (360) 734-0550.

• Patient Name Email Date of Your Last Visit How was the treatment you received?
  Please Rate Excellent Very Good Average Poor

  How comfortable were you?
  Please Rate Very Comfortable Reasonably Comfortable Uncomfortable

  Was your treatment explained to you so that you have a clear understanding of your dental situation?
  Please Select Yes No

  How well were your financial options explained to you?
  Please Select Excellent Good Poor Not at All

  Were you seated close to your appointed time?
  Please Select No Wait 15 Minutes 30 Minutes 45 Minutes

  Would you refer your friends and family to us?
  Please Select Yes No Maybe

  Additional Comments