Feedback Survey

How would you rate your overall experience?
1-Very Poor 2-Poor 3-Average 4-Good 5-Excellent

How would you rate the cleanliness of the office?
1-Very Poor 2-Poor 3-Average 4-Good 5-Excellent

How would you rate the temperature of the office?
1-Too Cold 2-Cold 3-Just Right 4-Warm 5-Too Warm

Ease of scheduling?
1-Very Poor 2-Poor 3-Average 4-Good 5-Excellent

How would you rate your interactions with the staff?
1-Very Poor 2-Poor 3-Average 4-Good 5-Excellent

How would you rate your interaction with the doctor?
1-Very Poor 2-Poor 3-Average 4-Good 5-Excellent

Would you like to share any additional comments or feedback?

Which office did you visit?

Pedodontic Associates - Dentistry for Infants, Children, & Adolescents