Survey

Name (optional):   Date of Birth:

Facilities Strongly Agree Agree Neutral Disagree Strongly Disagree Not Applicable
The Office location and parking were convenient.
The reception area was neat and clean.
The Equipment was clean and presentable.
The temperature in the office was comfortable.
             
Staff Strongly Agree Agree Neutral Disagree Strongly Disagree Not Applicable
The Dentist was professional and courteous.
The Dental hygienist was professional and courteous.
The Dental Assistant was professional and courteous.
Front Office Staff was professional and courteous.
The Staff was considerate and sensitive to my needs.
             
Treatment Strongly Agree Agree Neutral Disagree Strongly Disagree Not Applicable
The proposed treatment was clearly explained to me.
Treatment alternatives were given.
All of my questions were answered.
Treatment was completed in a timely and efficient manner.
I am pleased with the quality of the dental treatment.

Comments:

Amando Dental

4540 Southside Blvd. | Suite 801 | Jacksonville, Florida 32216
(904)642-2010 | Fax: (904)642-8282 | info@amandodental.com