At Chemung Family Dental we know the importance of patient feedback; about the office and your care.

We feel very strongly this is the only way we can truely know how our patients
are grading our performanceThis is totally "confidential" you do not need to include your email or name,
unless you wish to.

1) Are you a new patient?


2) Did you see the hygienist or doctor today?

3) Was your visit today for routine care or an emergency?


4) Were you greeted immediately upon entering the office?


5) Was the staff friendly and helpful?


5a) Was your treatment, fees, etc. adequately explained to you?


6 )Were you seen promply?


6a) If not how long did you have to wait past your scheduled time?


7) Were your needs met at this visit?


7a) Did we complete the treatment you expected us to today? (Please explain)

8) Overall how would you rate your experience at our office today?
- Please check the box that applies & use the comment section to add any additional information)

My experience today at Chemung Family Dental was below what I expected it to be

My experience today at Chemung Family Dental was what I expected it to be

My experience today at Chemung Family Dental was above what I expected it to be

Chemung Family Dental far exceeded my expectations today

Additional Patient Feedback:

If desiered but not necessary.

Your Name:

e-mail address: