Test page

Dr. Beaufait Patient Survey

Thank you for taking the time to improve our practice. Your suggestions are important to us!

Patient Name (optional)

Your Name (optional)

Please rate the following categories:

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
First impression of the office	12345
Initial phone contact	12345
Did the staff greet you properly at the time of your visit?	12345
Were the assistants & hygienist friendly and professional to you and your child?	12345
Was the doctor professional and courteous to you and your child?	12345
Did cleanliness of our practice meet your expectations?	12345
Were your financial matters handled in a timely and well addressed manner?	12345
Would you refer your friends and family to us?	12345

Further suggestions, comments or testimonials...