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  Your Name:
  Email Address:
  Were you treated in a professional manner?
  Yes      No
  Were you seen on time?
  Yes      No
  Did the doctor spend enough time with you?
  Yes      No
  If you used our website, was it easy to navigate, useful and helpful?
  Yes      No
  Would you give the dentist who referred you to us a good report?
  Yes      No
  Were you acknowledged when you entered our office?
  Yes      No
  Do you feel that the dental procedures you received helped you?
  Yes      No
  Did you understand the reason and need for the dental procedures you required?
  Yes      No
  If you have dental insurance, do you feel that we explained the level of reimbursement adequately?
  Yes      No
  Did you understand the treatment plan presented to you?
  Yes      No
  For the following questions, please rate us.
  How likely are you to recommend us to someone else?
 
 Excellent  Average  Poor
  How would you rate our overall service?
 
 Excellent  Average  Poor
  What rating would you give the referring dentist about your visit with us?
 
 Excellent  Average  Poor
  Questions, comments, or suggestions:
 

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Copyright © 2018 Krystal Miles, DDS, MS