• 360.972.3330
  • 718 Yelm Ave West Yelm, WA 98597
  • Mon-Thur: 7am-4pm Select Fridays from 7am-12pm

Rate your Dental Visit


2) What was the nature of your visit?

3) Were you seated on time?


5)  Please rate your satisfaction on a scale of 1 to 10 with 10 being highly satisfied.  Not applicable is also a choice.

Ease of scheduling an appointment

Friendliness of the staff and Doctor




6)  How would you rate your hygienist in the following categories on a scale from 1 to 10 with 10 being highly satisfied? 





7) Would you like to try a different hygienist?

Rate the next four questions only if you received anesthesia and had a procedure performed during your visit.  If not, skip to question 13.

8)  What type of procedure(s) were performed?


10) Were you satisfied with how numb you were throughout the procedure?

11) On a scale of 1-10, how satisfied are you with the finished result of your procedure?


Overall Experience


13) Would you refer a friend to our practice in the future?

Thank you for taking the time to complete this survey.  Your feedback will enable us to improve our patient care and make your future visits as positive as possible.