Satisfaction Survey

Please complete and submit our Patient Satisfaction Survey below

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

    From the Dentist’s Chair

    Reviews