Patient Review Form

 

First Name
Last Name
Email
Phone



How would you rate your overall visit?
ExcellentVery GoodAverageNot so good


When your appointment was over, did you have an good understanding of your dental situation?
YesNot reallyI wish I knew more


Did you have to wait past your appointment time to be seated? If so, how long?
No15 to 30 minutes30 to 45 minutesOver 45 minutes


Did our team greet you properly?
YesNot reallyI don't recall


The greatest compliment our patients can give us is the referral of their friends and loved ones. Would you refer your friends & family to Share More Smiles?
YesNoI am not sure


By checking the "Yes" option you agree to allow us to publish your survey on our website and social media channels using your first name and last initial.
YesNo


Please comment on anyone you met during your visit, things we could change, new services you would like to see, or other ways we can make you feel more comfortable.