Satisfaction Survey

Consent:

I consent to my submitted data being collected and stored in accordance to the Lancaster Dental Associates Website Privacy Policy.

Name:

Phone Number:

Email Address:

Was this your first visit to our office or have you been here before?

1st Visit

Repeat patient

Who did you see?

What was the purpose of your visit?

Ease of setting your appointment:

Poor Fair Okay Good Great

Greeting by our receptionist when you arrived:

Poor Fair Okay Good Great

Cleanliness/neatness of the waiting room:

Poor Fair Okay Good Great

Cleanliness/neatness of the operatory:

Poor Fair Okay Good Great

Length of time you had to wait before you were called for your appointment:

Poor Fair Okay Good Great

Friendliness of our office staff:

Poor Fair Okay Good Great

Friendliness of the dentist:

Poor Fair Okay Good Great

Quality of the service performed:

Poor Fair Okay Good Great

Degree to which your concerns were addressed by either the technician or the dentist:

Poor Fair Okay Good Great

The ease of checking out and paying after the appointment:

Poor Fair Okay Good Great

The explanation of fees and/or insurance benefits:

Poor Fair Okay Good Great

How likely is it that you would recommend our dental office to your family members, co-workers, and friends?

Poor Fair Okay Good Great

In your own words, let us know any issues or concerns you may have about our services or office practices and procedures.

Lancaster Dental Associates

237 W. Hickory St.
Lancaster, WI 53813

608-723-2141

Office Hours

Monday - 8 a.m. to 5 p.m.

Tuesday - 8 a.m. to 5 p.m.

Wednesday - 8 a.m. to 5 p.m.

Thursday - 8 a.m. to 5 p.m.

Friday - 8 a.m. to 2 p.m.

Fennimore Smiles

1515 Lafollette St.
Fennimore, WI 53809

608-822-4500