Patient Survey

How would you rate your overall visit with us?
Excellent    Very good    Average   Not good

Did we make you feel welcome and serve you in a friendly manner?
Yes    No

Did you have to wait 15 minutes past your scheduled appointment time to be seated? If so, how long?
No    15 - 30 Min    30 - 45 Min    Over 45 Min   

Did you feel that everyone was concerned about your total wellbeing as a person, not just your dental needs?
Yes    No

Did you feel that you understood the treatment prescribed and that all of your questions were answered to your satisfaction?
Yes    No

Would you refer Dr. Marty Cloin to your family and friends?
Yes    No

Are there any staff members you would like to thank for outstanding care or service?

Jennifer       Milla       Dena      
Michelle        Mary      Kristen   

* Name:

* E-mail:

Any comments are appreciated.

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