Dr. Peterson appreciates you taking the time to complete this patient survey. All comments you choose to make are confidential and are used to help Smiles Created Daily become better in the future.

Patient Feedback Patient Name Email Address 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 understood 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 us? Yes No I'm not sure Please comment on how we could make your visit better, new services you would like to see, or other ways we can make you feel more comfortable.   Confirmation code: * To ensure security of all using this form, please enter the confirmation code.