Thank you for visiting Perry Dental. We value your feedback about your experience so we can provide you with the best service possible.
First Visit YesNo
Type of Visit CleaningRestorativeDentistryEmergencyExam & X-RaysCosmeticDentistryConsultation
On a scale of 1-5 with 5 being Excellent, please rate your last visit with us. (1-Poor, 2-Fair, 3-Good, 4-Very Good, 5-Excellent)
Ease of setting your appointment 12345
Greeting by our receptionist when you arrived 12345
Cleanliness/neatness of the waiting room 12345
Cleanliness/neatness of the procedure suite 12345
Length of time you had to wait before you were called for your appointment 12345
Friendliness of our office staff 12345
Friendliness of the dentist 12345
Ability of Dentist to put you at ease 12345
Quality of the service performed 12345
Degree to which your concerns were addressed by either the technician or the dentist 12345
The ease of checking out and paying after the appointment 12345
How likely is it that you would recommend our dental office to your family members, co-workers, and friends? 12345
In your own words, let us know any positive experiences you had or issues or concerns you may have about our services or office practices and procedures.
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