Customer Satisfaction Survey

Thank you for visiting YELM DENTAL. To help us maintain a high quality of service, please provide us with feedback by filling in the information below. There are 4 pages and it should take you about 5 minutes.

* Date of Visit:

* Was this your first visit to Yelm Dental?

Yes

No

Scheduling and Financial/Insurance Benefits

* Please choose the best answer for each of the following.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Other / Comment
I found it easy to make an appointment.
The office receptionists are courteous and helpful.
My appointment time was convenient with my schedule.
Billing and payment options met my financial needs.
The staff was helpful with my insurance benefits.
I appreciated the appointment confirmation card and/or call.

* Indicates Response Required