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214-352-ROOT (7668)
2924 W. Northwest Hwy. Dallas, TX 75220
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Endodontic Treatments
Sedation
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Take Survey
Take A 1-Minute Patient Satisfaction Survey
Help us serve you better by taking this survey.
Please fill the basic details
por favor complete los datos básicos
Patient Name/Nombre del paciente
Appointment date/Día de la cita
Appointment date/Día de la cita: Date
Appointment date/Día de la cita: Time
Form Item
When you arrived at our office, was the front office staff friendly and professional?
Cuando usted ilego a nuestra oficina, fue el personal de reception amable y professional?
YES/sí
NO/no
Form item
Did you receive a text message about the appointment?
recibio un mensaje de texto. sobre su cita?
YES/sí
NO/no
Did this help you remember?
YES/sí
NO/no
Form Item 3
How would you rate the cleanliness of the office?
como calificaría la limpieza de nuestra officina?
GOOD/bien
AVERAGE/promedio
POOR/pobre
Form Item 4
Do you feel the clinical staff (Doctors & Assistants) treated you with care?
siente que el personal clinico (medicos & asistentes) lo trataron. con cuidado?
GOOD/bien
AVERAGE/promedio
POOR/pobre
Form Item 5
Do you feel like we value your time?
sientes que valoramos tu tiempo?
YES/sí
NO/no
Form Item 6
Would you refer us to your friends or family?
nos recomendaría a sus amigos o familiares?
Yes
No