Welcome to Dental Health Group

Dear Dental Health Group Patient:

Dental Health Group wants to provide you with the best care possible. Your views will help us improve our services to you, and will also let us know when we are doing a good job!

Please tell us about your visit:
Your Chart Number:
Which facility did you visit?
	Very Satisfied	Satisfied	Slightly Satisfied	Not at all Satisfied
Able to get an appointment at a convenient time.
Appearance of facility was attractive.
Front office staff was courteous and helpful.
All clinical staff wore gloves, masks and eye protection during treatment.
The dental care provider listened to my concerns.
The dental care provider advised me about my treatment before actually beginning.
Staff members advised me of the cost for treatment before beginning.
The dental care provider tried to ease my discomfort during the visit.
I was satisfied with the quality of the dental care I received.
The dental care provider managed my main concern for this visit.
I would refer a family member or friend to this DHG facility.	Yes		No
Comments

Thank you! To be entered into the prize giveaway, enter your contact information below. Or to skip it, just click "Submit".

Enter your info to win a Free Cruise! *
First Name:		Last Name:
Address 1:		City:
Address 2:		State:
Phone:		Zip:
Email:

* Terms and Conditions

This offer excludes Dental Health Group employees and their families. Offer valid July 1, 2008 through September 30, 2008. Exact prize details will be determined by Dental Health Group and are subject to change. Your personal information will only be used to notify you in case you win a prize, and will not be associated with your survey response. Your privacy is very important to us and we will never disclose any of your personal information to third parties.