Advanced Dentistry at Century Square - Dr. Andreea Larhs

Dr. Andreea Larhs, DDS PS
Appointments: 206.292.9900

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PATIENT SURVEY

We care about the level of service we offer to you. We would be grateful if you would fill out this survey to let us know what you like about our practice and to also let us know in what areas we need to take action to correct and improve our services to you.

The results of this survey are private and will be kept confidential. We respect your privacy.

Was this your first visit?

Yes

What was the purpose of your visit?

How would you rate your experience on your last visit? If a particular line does not apply to your visit, please move on to the next question.

Great

Good

Okay

Fair

Poor

How would you rate your overall visit?

Greeting by our staff when you arrived?

Cleanliness/neatness of the waiting area?

Cleanliness/neatness of the treatment room?

Friendliness of our office staff?

Bedside manner of the dentist?

Length of time you had to wait before you were called for your appointment?

Length of time you had to wait while in the chair receiving your care?

Quality of the service performed?

The ease of checking out and paying after the appointment?

Degree to which your concerns were addressed by either the technician or the dentist?

When your appointment was over did you have a good understanding of your dental situation?

Yes

I wish I knew more

Were your financial options explained to you?

Yes

I already understand my finacial options

How likely is it that you would refer your friends, family members or co-workers to our office?

Very likely

Not likely

Not sure

Please comment on how we can make your visit better or anything you would like us to know:

If you would like to provide us with your contact information please use the boxes below:

Name:
Email:
Phone #: