Tifton Regional Dental Group Patient Survey Form

*Patient Survey*

Thank you for choosing us as your dental practice. We are always looking for ways to improve our service to you and make you feel right at home.
Please complete the following information by selecting the most appropriate answer based on your recent visit.

Patient Name (optional)

E-mail address (optional)

Who were you here to visit today?
Dr. Phillips Dr. Hasty Dr. Crawford Laura
Beth Cristi Del Donna Rewa Whitney

How would you rate your overall visit?
Excellent Very Good Good Fair Poor

When your appointment was complete did you have a good understanding of your dental situation?
Yes Not really I would like to know more

Were your financial options explained to you?
Yes No I already understand my financial options

Did you have to wait past your appointment time to be seated? If so how long?
No 1 to 5 minutes 5 to 10 minutes 10 to 15 minutes Over 15 minutes

Did the staff greet you promptly and courteously?
Yes No I don't recall

Would you refer your family and friends to Tift Regional Dental Group?
Yes No I'm not sure

How did you first hear about us?

Please comment on the staff in general, any staff member you met during your visit, things we could improve, new services you would like to see, or other ways we can make you feel more comfortable: