Logo

Dr. Ali Shirani

3725 Lone Tree Way #F, Antioch, CA 94509

925-778-1998

Patient Survey

Thank you, for choosing our dental practice to help you maintain good oral health. We appreciate your trust and confidence in us. We are here to render caring, quality dental care, promptly and professionally, in a pleasant and friendly atmosphere. We put our patients first in all we do. We appreciate you taking the time to complete our survey. We aspire to consistently maintain high standards of excellence and patient satisfaction. Your input will help us improve and serve you better. Any comments you make are kept strictly confidential and can only help us become better.

Doctor's Name
Patient Name
E-Mail address
Phone
How would you rate your overall visit?
Were you greeted when you arrived?
Was the Receptionist helpful?
Were you seen by the dentist in a reasonable amount of time?
If you answered no to the above question then how long was the wait?
Were your financial options explained to you?
Did you understand the cost before the treatment was started?
How was the quality of Care?
Did your dentist manage your Discomfort?
How was your cleaning?
Was the Assistant helpful and courteous?
How would you rate the Cleanliness of our office?
When your appointment was over, did you have a good understanding of your dental situation?
Would you recommend your friends and family to us?
Please comment on how we can make your visit better.

© 2024 - American Dental Software All rights reserved.