1618 E. Morehead St., Suite 100, Charlotte, NC. 28207
 
(704) 337-8070
 

 
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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.

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? :
Please comment below on how we could make your next visit better and more comfortable.  Thank you.:


 
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New Patient Offer

Must sign up by: 08/06/2010

The first 20 patients who schedule their initial appointment each month can choose one of the 2 offers below:

$97. Teeth Whitening!
(Regularly $400.00...Save $301.00)

OR

$100.00 Savings Certificate!
Can use toward any out of pocket expenses in our office.
(Perfect for patient without dental insurance)

Call us today or complete the form below.  Thank you.

New Patients Only. This offer cannot be combined with any other offers.



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Advanced Dentistry of Charlotte · 1618 E. Morehead St., Suite 100 · Charlotte, NC · 28207 · (704) 337-8070
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