Crystal Lake Dentist
 
Call Now: (815) 356-0045
FAX: (815)356-0181
bsd@brinkstreetdental.com
  Patient Survey
       

Please take a moment to complete our survey.  Your comments are welcome and completely confidential. Your input will help us improve our service.  Thank you.

We appreciate you taking the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us become better in the future.

Patient Name (optional):
E-mail Address (optional): 
Date of your last visit (optional):
How was the treatment you received :
How comfortable were you during the treatment you received :
Was your treatment explained to you so that you have a clear understanding of your dental situation :
Were your financial options explained to you? :
How long did you wait before being seated in a room?
Would you refer your friends and family to us? :
Please comment below on how we could make your next visit better and more comfortable.  Thank you.:


 
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Crystal Lake Dentist
 
 

NEW PATIENT OFFER

Our Gift to You:
a $30 VISA Gift Card.

One gift card per new family account. Referrals made within existing accounts are ineligible.

First visit is defined as a comprehensive exam with complete x-rays and cleaning, or any type of restorative care. Card choices subject to change without notice, based on availability.

Simply complete the form below.  Thank you.


     
     
- patientsurvey -