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228 N Main Street, New City, NY 10956
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Patient Satisfaction Survey

We hope that you have had a comfortable and pleasant experience in our office. It is our greatest pleasure to have you as a patient! As you know, our practice is committed to 100% patient satisfaction. Because we are proud of the beautiful smiles we have created in this community, we want you to be excited about all of the services we provide. We value your opinion and would greatly appreciate it if you would take a moment to share your impressions of our practice. Thank you for your time!
A = Excellent    B = Average    C = Could be improved
1. I am embarrassed of my teeth and try not to smile
2. I worry about what others think of my smile
3. My smile has a negative impact on my self confidence
4. I have thought about making changes to my smile
5. I believe an improved smile would help me feel more confident in social and professional situations
6. I believe correcting the imperfections in my smile would make it easier to maintain optimum oral health
 
 
How did you hear about us?
 
Do you have any additional comments that would help us to improve?
Comments:
If you would like us to contact you regarding any of your comments, please provide your contact information:
name:
phone:
email:
 
© Clarkstown Dental PLLC | Treeline Dental Websites
© Clarkstown Dental PLLC | Treeline Dental Websites
Clarkstown Dental PLLC
228 N Main Street, New City, NY 10956
Phone: (845)634-8111