On your last visit you saw? * Doctor Dentist Lab Social Worker WIC The way you were treated by the staff? * Great Good Fair Poor Doesn't apply The time it took to get your appointment? * Great Good Fair Poor Doesn't apply The time it took to see the nurse/dental assistant? * Great Good Fair Poor Doesn't apply The amount of time the doctor/dentist spent with you? * Great Good Fair Poor Doesn't apply The way things were explained to you? * Great Good Fair Poor Doesn't apply The caring and professional attitude of the staff? * Great Good Fair Poor Doesn't apply The cleanliness of the clinic? * Great Good Fair Poor Doesn't apply Who did you see on your last visit? * Give the doctor/dentist's name. Would you recommend this clinic to family and friends? * Yes No If no, why? * At the end of visit, were you clear about your next appointment, test/x-ray results,and referrals? If no, why? * Was this your first visit to our clinic? * Yes No Please leave any other comments you may have. Leave this field blank
