Contact this North Dallas Dentist!

You can call us during office hours (M-Th, 7:30-4:00) at (214) 739-8888, or use the form to email us directly. If this is a dental emergency and you are in pain outside of normal working hours, call the number above and listen to the recording to get the emergency number active today.

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Sign-up For Email Newsletter

Are you interested in new tasty recipes? Want to test your mind with trivia? Care to know what's new in the world of dental care? Then sign up for our monthly email newsletter by giving us your email address below:
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Cosmetic Dentist? Yes    No   

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Patient Survey & Feedback Form

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 don't always know how we're 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 we'd 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!
Part 1
Name:*
Date of visit:*
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   

If not a patient, may we contact you about a consultation?*
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 not)
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.

Part 2

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!