| The person who answered the phone when I called was: |
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| Do you find your appointments are scheduled at convenient times? |
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| Upon entering our building, were you warmly greeted and acknowledged by our staff? |
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| How long did you wait before being seen at our office? |
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| The assistant(s) was friendly, supportive and confident: |
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| The hygienist(s) was confident, friendly, and focused: |
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| Dr. Kaplansky was confident and focused: |
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| The treatment I received was: |
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| Did Dr. Kaplansky explain your treatment, answer your questions, and listen to your concerns? |
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| Were options for your financial arrangements explained to you? |
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| Would you recommend us to your friends, co-workers and family? |
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| If you are a new patient, how did you hear about us? |
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| Comments: |
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