Patient Survey Please note that e-mail is not a secure form of communication and medical information placed here may not be secure. Only use this as a contact form to reach our office directly so we may contact you back using a secure method. Children under the age of 18 should not use this form. If you prefer to speak to us directly you are also welcome to call us so that we may assist you:Name* First Last Email* Who did you see during your visit?How would you rate your overall visit on a scale from 1 to 5?54321(1 being least satisfied and 5 being most satisfied)When your appointment was over did you have a good understanding of your dental situation? Yes NoWere all of your dental questions answered? Yes NoWere your financial options explained to you? Yes NoDid you have to wait past your appointment time to be seated?If so, how long?Did the staff greet you properly?Would you refer your friends and family to Spanish Hills Dental? Yes No UndecidedCommentsPlease comment on anyone you met during your visit, things we could change, new services you would like to see, or other ways we can make you feel more comfortable:PhoneThis field is for validation purposes and should be left unchanged.