Services
Anxiety Free Dentistry
Dentures
Fresh Breath
Invisalign Invisible Braces
Laser Cavity Finder
Lumineers
Oral Cancer Screening
Smile Makeover
Treating Gum Disease
Zoom! - Teeth Whitening
Specials & Coupons
About Us
About Your Doctor
About Your Team
News About Us
Office Info
Ask The Doctor
Financing
Map & Directions
New Patient Forms
Office Tour
Patient Survey
Privacy Policies
Smile Gallery
Home
Select Service...
Anxiety Free Dentistry
Dentures
Fresh Breath
Laser Cavity Finder
Lumineers
Oral Cancer Screening
Smile Makeover
Treating Gum Disease
Zoom! - Teeth Whitening
Are you a new patient?
Yes
No
We appreciate you taking the time to complete our survey and commenting on how we could make your visit better or other ways we can make you feel more comfortable.
*
First Name:
*
Last Name:
*
E-Mail Address:
1. How would you rate your overall visit?
Excellent
Very Good
Average
Not So Good
2. When your appointment was over did you have a good understanding of your dental situation?
Yes
Not Really
I wish I knew more about my situation
3. Were your financial options explained to you?
Yes
No
I already understand my financial options
4. Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?
No
15 to 30 Minutes
30 to 45 Minutes
Over 45 Minutes
5. Did the team greet you properly?
Yes
Not Really
I Don't Recall
6. Would you refer your friends and family to our practice?
Yes
No
I'm Not Sure
Comments:
Services
|
Specials & Coupons
|
About Us
|
Office Info
|
Smile Gallery
|
Privacy
|
Home
8060 Via Dellagio Way, Suite 202 Orlando, FL 32819 | (321) 332-0046
View All Heartland Dental Care Offices