Botox, Invisalign & Da Vinci Veneers Dallas


	7515 Greenville Avenue Suite 810 Dallas, TX 75231 (214) 739-8888 Hours: M-Th 7:30-4:00 Directions
Dr. Mary Swift		Dr. Melisa Christian

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The entire staff at Dallas Laser Dentistry wants to make sure your time with us is productive, high quality, and enjoyable. We try to make this happen for every patient, but since everyone is different we donÒt always know how weÒre doing.

It would help us improve yours and others future experience with us if you would take the time to fill out the following survey. Part 1 weÒd like you to complete in full; Part 2 is designed to give us more detailed feedback and may be done entirely or by completing only those sections you deem important. Thank you for your time and for being a patient!

Part1
Name
Date of visit (mm/dd/yy)
Time of Appt
Dr. Seen
How would you rate the doctor? (1-5, 1 being outstanding)
Hygienist Seen
How would you rate the hygienist? (1-5, 1 being outstanding)
How would you rate your overall experience? (1-5, 1 being outstanding)
Based upon your experience, will you come back to us for any treatment?
Was a treatment plan recommended to you, and costs explained to you?	Yes No
Were financing options offered?	Yes No
Are you going to complete the treatment plan in the next 30 days?	Yes No
Have you scheduled your first/next appointment for a cleaning?	Yes No
Based on your experience, would you refer us to a friend/associate? (1-5, 1 - definitely yes!, 5 - definitely no!
What did like best about your visit?
If you were to refer us to someone, what specific thing(s) would you mention?
What could we improve?
How did you first hear about the office?
Comments

Thank you for your feedback. If you can spare some more time, please review the questions in Part 2 and answer those for which you care to express an opinion.

Part2 Appointment/Reception
Please rate how you were treated on the phone and when you arrived and checked-in (1-5)
Were the informational videos playing in the reception area helpful/interesting?	Yes No
If a new patient, had you completed the required forms (online or printed) before arriving for your appointment?	Yes No
Is this a helpful option?	Yes No
Were you moved from the reception area in a timely manner?	Yes No
Comments

Operatories
Was the Chairside assistant friendly and informative?	Yes No
Was it helpful seeing your digital X-rays on the screen?	Yes No
Was it helpful seeing intraoral pictures of your mouth?	Yes No
Were the educational videos in the operatory informative?	Yes No
Did you enjoy the chair massage?	Yes No
Did the doctor/hygienist explain needed and optional treatment?	Yes No
Did the doctor/hygienist acknowledge your needs?	Yes No
Was the doctor/hygienist friendly and did she put you at ease?	Yes No
Were the procedures performed in a comfortable manner?	Yes No
Comments

Treatment Plans/Financing
Was any treatment plan recommended?	Yes No
Were the costs of the treatment plan reviewed with you?	Yes No
Were financing options offered?	Yes No
Was the treatment plan completed on this visit?	Yes No
If not, do you intend to complete all the work recommended in the next 30 days?	Yes No
Was the person presenting the payment options courteous, knowledgeable, and helpful?	Yes No
Comments

Check-Out
Was your balance due for today's procedures ready when you were ready to leave?	Yes No
Was the person checking you out friendly and helpful?	Yes No
Did they explain what portion we expect insurance to pay, and what portion was to be covered by you?	Yes No
Did you schedule your next appointment before leaving?	Yes No
Comments

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Thank you for your feedback and please come see us again! << back

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