Request edit access
Patient Survey
We want to hear about how your experience was at Castleberry Dental! This survey is purely to help the business grow, so please answer honestly.
Was this your first visit to our office or have you been here before?
If you answered "1st Visit," how did you hear about us?
Your answer
What was the purpose of your visit?
Your answer
On a scale of 1 to 5, with 5 being "Great," how would you rate your experience on your last visit? If a particular line does not apply to your visit, please skip it.
Ease of setting your appointment
Greeting by our receptionist when you arrived
Cleanliness/neatness of the waiting room
Cleanliness/neatness of the operatory
Length of time you had to wait before you were called for your appointment
Friendliness of our office staff
Friendliness of the dentist
Quality of the service performed
Degree to which your concerns were addressed by either the technician or the dentist
The ease of checking out and paying after the appointment
How likely is it that you would recommend our dental office to your family members, co-workers, and friends?
In your own words, let us know any issues or concerns you may have about our services or office practices and procedures.
Your answer
In your own words, let us know of any improvements you would have to the environment of the office.
Your answer
If you would like to provide us with your contact information, please use the boxes below:
Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms