Questions marked with a * are required
100%

Eagle Dental Associates Survey
 
How do you rate your telephone contact with our office? *
 
 
 
      
 

Who was your appointment with today? *
 
 
 
 
 
 
 
 
 
 
 
 
 

How long did you wait before being seated? *
 
 
 
 
 
 
 

Which of these amenities were you offered during your visit? *
 
 
 
 
 
 
 
 
 

After your appointment did you have a good understanding of your dental health? *
 
 
 
 
 

Were your treatment options explained to you? *
 
 
 
 
 
 

Were your financial options explained to you? *
 
 
 
 
 
 

Have you read our mission statement? *
 
 
 
 

If yes, do you feel we fulfill it? *
 
 
 
 
 
 

Do you feel you are treated with respect at our office? *
 
 
 
 
 
 

Do you feel members of our team listen to your concerns? *
 
 
 
 
 
 

How would you rate your overall visit? *
 
 
 
 
 
Would you recommend our office to others?
   
If not, why?
   
 
 

Please provide any other comments, and your name (if you choose) Thanks for completing our survey!