Which dentist did you visit? (Required)
Which dentist did you visit?
 Dr. EbenDr. Hakimi

What was the date of your visit?

Do you usually wait more than 15 minutes for a scheduled appointment?
Do you usually wait more than 15 minutes for a scheduled appointment?
 AlwaysSometimesNever

During your appointment, does your dentist appear familiar with your chart and dental history?
During your appointment, does your dentist appear familiar with your chart and dental history?
 AlwaysSometimesNever

Does your dentist explain why treatment is recommended?
Does your dentist explain why treatment is recommended?
 AlwaysSometimesNever

Does your dentist answer your questions and explain things clearly?
Does your dentist answer your questions and explain things clearly?
 AlwaysSometimesNever

Does your dentist spend enough time with you?
Does your dentist spend enough time with you?
 AlwaysSometimesNever

Are you treated courteously and respectfully by your dentist and staff?
Are you treated courteously and respectfully by your dentist and staff?
 AlwaysSometimesNever

Do you see your dentist as being approachable, sympathetic, and understanding?
Do you see your dentist as being approachable, sympathetic, and understanding?
 AlwaysSometimesNever

Does the dentist make sure you are comfortable during treatment?
Does the dentist make sure you are comfortable during treatment?
 AlwaysSometimesNever

Your Hygienist

Which hygienist worked with you during your visit? (Required)
Which hygienist worked with you during your visit? (Required)
 Karla SparksKim WilsonApril Larsen

What was the date of your visit?

Do you usually wait more than 15 minutes for a scheduled appointment?
Do you usually wait more than 15 minutes for a scheduled appointment?
 AlwaysSometimesNever

During your appointment, does your Dental Hygienist appear familiar with your chart and dental history?
During your appointment, does your Dental Hygienist appear familiar with your chart and dental history?
 AlwaysSometimesNever

Does your Dental Hygienist explain why treatment is recommended?
Does your Dental Hygienist explain why treatment is recommended?
 AlwaysSometimesNever

Does your Dental Hygienist answer your questions and explain things clearly?
Does your Dental Hygienist answer your questions and explain things clearly?
 AlwaysSometimesNever

Does your Dental Hygienist spend enough time with you?
Does your Dental Hygienist spend enough time with you?
 AlwaysSometimesNever

Does the Dental Hygienist make sure you are comfortable during treatment?
Does the Dental Hygienist make sure you are comfortable during treatment?
 AlwaysSometimesNever

The Office

Is the office clean, comfortable and professional in appearance?
Is the office clean, comfortable and professional in appearance?
 AlwaysSometimesNever

Is adequate parking available?
Is adequate parking available?
 AlwaysSometimesNever

Is there a variety of appropriate reading material available in the reception area?
Is there a variety of appropriate reading material available in the reception area?
 AlwaysSometimesNever

Is the telephone answered promptly?
Is the telephone answered promptly?
 AlwaysSometimesNever

Are you able to get an appointment in what you consider to be a reasonable amount of time?
Are you able to get an appointment in what you consider to be a reasonable amount of time?
 AlwaysSometimesNever

Does the office staff assist you in filling out insurance and other forms?
Does the office staff assist you in filling out insurance and other forms?
 AlwaysSometimesNever

Does the office staff maintain your privacy when discussing financial arrangement and other personal matters with you?
Does the office staff maintain your privacy when discussing financial arrangement and other personal matters with you?
 AlwaysSometimesNever

Does the office staff notify you if appointments are running behind schedule?
Does the office staff notify you if appointments are running behind schedule?
 AlwaysSometimesNever

Would you refer your friends and family to Westlake Smile Design?
Would you refer your friends and family to Westlake Smile Design?
 YesNo

Have you referred any patients to Westlake Smile Design?
Have you referred any patients to Westlake Smile Design?
 YesNo

Full Name (Optional)

 

Email Address (Optional)

 

Phone Number (Optional)

 

We would greatly appreciate any additional feedback::
Additional Feedback