Patient Survey
 

Please take a moment to complete our survey.  Your comments are welcome and completely confidential. Your input will help us improve our service.  Thank you.

We appreciate you taking the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us become better in the future.

Send us an email message via this form.
Patient Name :
E-mail Address :
Date of your last visit:
How was the treatment you received :
How comfortable were you during the treatment you received :
Was your treatment explained to you so that you have a clear understanding of your dental situation :
Were your financial options explained to you? :
How long did you wait before being seated in a room?
Would you refer your friends and family to us? :
Please comment below on how we could make your next visit better and more comfortable.  Thank you.:


 
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Dr. Beaver and his staff would like to extend a warm welcome to you and your family.

TWO REMARKABLE
“GET ACQUAINTED” OFFERS!

FREE First Exam
or
FREE Teeth Whitening

($450 Value)
Exam includes X-Rays and Consultation with the Doctor

Offers have no cash value.
One offer per patient.
Offers are for New Patient only!

Offer Expires:  03/14/2010

Complete the form below
to take advantage of
these limited time offers.


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