We believe in constant improvement and striving for excellence . Your answers to the following questions are extremely valuable. All comments help us enrich our quality of care and customer service. We are proud to be your dental office so tell us how we can serve you better.

5 = extremely satisfied, 4= very satisfied, 3 = satisfied, 2= dissatisfied, 1= very dissatisfied

Your Name (optional - please put "confidential" if you prefer to remain anonymous)

Your Email (optional - please put "blank@yahoo.com" if you prefer to remain anonymous)

How satisfied were you with the quality of service?

Are you satisfied with the quality of dentistry?

How would you rate the way you were treated by:

Dr. Chu
Marla (Front Office)
Jennifer Treatment Coordinator)
Kristin (Treatment Coordinator)
Sandy (Dental Hygienist)
Maryam (Dental Hygienist)
Denise (Dental Hygienist)

Are you happy with the smoothness and efficiently of your appointment(s)?

How would you rate the way your billing, financial arrangements and insurance are handled?

Are you satisfied with the promptness of your appointment(s)?

Do you feel comfortable referring friends, family and co-workers to this office?
If not, why?

In the space below, please feel free to provide additional comments or feedback regarding your visit(s). Thank You!