| Patient Name: |
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| Email: |
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| How would you rate your most recent visit overall? |
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| Were you greeted promptly and pleasantly upon your arrival to the office? |
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Were you seated for your appointment on time? If not, were you kept properly informed of the change to your appointment time? How long was your appointment delayed?
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| Do you feel like you have a good understanding of your oral health and your treatment options? |
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Were your payment options and insurance benefits explained well to you? |
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Do you feel like the Dr. Kalarickal or empowered team members offered you the time you needed for your treatment questions? |
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Would you recommend your friends and family to us? |
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| Which team member encouraged you to complete this survey? |
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Please advise us on any ways we can improve our service for you and your family and on anything we are doing well currently.
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| May we utilize your comments as a testimonial on our webpage or other practice promotion material? |
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