Patient Review Form


First Name
Last Name

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.

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.