Please complete the following information selecting the most appropriate answer based on your visit.

How would you rate your overall visit?
Excellent Very Good Average Not so good

When your appointment was over did you have a good understanding of your dental situation?
Yes Not really I wish I knew more about my situation

Were your financial options explained to you?
Yes No I already understand my financial options

Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?
No 15 to 30 minutes 30 to 45 minutes Over 45 minutes

Did the staff greet you properly?
Yes Not really I don't recall

Would you refer your friends and family to Miller and Miller?
Yes No I'm not sure



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