Eastgate Dentist - Patient Survey

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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.

Send us an email message via this form.


Patient Name :
E-mail Address :
Date of your last visit:
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? :
How well was the telephone answered? :
How helpful and friendly was the receptionist? :
Was your dental insurance and estimated share handled properly? :
Level of office cleanliness? :
Did you have any difficulty scheduling appointments?

Please comment below on how we could make your next visit better and more comfortable. Thank you.: Please enter code above in the field below.

NOTICE: We cannot guarantee that any e-mail communications are secure. Please understand that this is a risk if you are requesting or sending medical, dental, financial or other confidential information be sent via e-mail. This e-mail is intended to be confidential and personal , intended only for the named recipient(s) above and may contain information that is privileged. The content of this e-mail is not intended to be construed as dental or medical advice and may not be a secure e-mail. If you have received this information in error, or are not the named recipient(s), please immediately notify sender, or our office at 513-528-1150, and delete this e-mail from your computer. Do not send an e-mail in an emergency situation, since an immediate response cannot be expected. Thank you.

New Patient Offer

Receive $50.00 off any Cosmetic or Restorative Dental Procedure

Existing Patient Offer

$50.00 off ZOOM! One Hour Whitening

Offers Expires: 03/21/2010

Complete the form below to take advantage of either of these offers.