Patient Survey

Request an Appointment

To make an appointment, fill out the form and we will contact you to discuss appointment times.

*Location:

*Name:

*Phone:

*Email:

*Required

Patient satisfaction is very important to us and we want to be sure we are meeting the needs of our patients. We appreciate you taking the time to fill out this survey.

Name (Optional):
Doctor you saw:

Please use the following scale when rating your experience:

5Excellent 4Very Good 3Average 2Poor 1Failure
The appointment coordinator was polite and helpful.
You were seen on time for the appointment; If not, please provide the reason given for the delay below.
The proposed dental treatment plan was clearly explained.
The facility was neat and clean (including instruments and equipment).
Overall satisfaction with your visit to Pointe Dental Group.

Comments/Suggestions: