Patient Survey

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:    
Patient Email:  
 
How would you rate your overall visit?
When your appointment was over did you have a good understanding of your dental situation?
Were your financial options explained to you?

Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?

Did our office team greet you properly?

Would you refer your friends and family to us?
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.
 




      

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Copyright 2012 Lane Eddleman, DDS. All Rights Reserved.
WELCOME TO OUR PRACTICE
MEET DR. EDDLEMAN
MEET OUR STAFF
VIRTUAL OFFICE TOUR
OFFICE POLICIES AND PROCEDURES
DOCTOR/PATIENT RELATIONSHIP
YOUR FIRST VISIT
TESTIMONIALS
PATIENT SURVEY
MAKE PAYMENT ONLINE
PATIENT REGISTRATION
INVISALIGN CONSENT FORM
TMJ EXAM QUESTIONAIRE
ZOOM INFORMED CONSENT
CARECREDIT PATIENT FINANCING
PATIENT RECORDS AND X-RAY REQUEST
POST-OPERATIVE INSTRUCTIONS FOR EXTRACTIONS
POST-OPERATIVE INSTRUCTIONS FOR SCALING & ROOT PLANNING
POST-OP INSTRUCTIONS FOR TEMPORARY CROWNS
PROFESSIONAL CUSTOM TRAY WHITENING
NEW IMMEDIATE DENTURE INSTRUCTIONS
NEW PARTIAL OR COMPLETE DENTURE INSTRUCTIONS
NEW SMILE PROTECTION PLAN
RECENT AND RELEVANT RESEARCH
PERIODONTAL DISEASE
DENTAL ANXIETY
BRUXISM – TOOTH GRINDING
ATHLETIC MOUTHGUARDS
XEROSTOMIA (DRY MOUTH)
DIABETES AND ORAL HEALTH
DRY SOCKETS
FLOURIDE
DENTAL ADVICE FOR MOMS & KIDS
RADIATION & CANCER THERAPY
TOOTH DECAY
DIGITAL X-RAYS
EMERGENCY DENTAL INJURIES
HALITOSIS
AMALGAM FILLINGS & MERCURY
WISDOM TEETH
INVISALIGN
DENTAL IMPLANTS
TOOTH COLORED FILLINGS
TOOTH WHITENING – ZOOM OR TRAY BLEACHING
PORCELAIN VENEERS - DURATHIN PREPLESS
PORCELAIN VENEERS – LUMINEERS
PORCELAIN VENEERS - TRADITIONAL
CROWNS
BRIDGES
BONDING
MICROABRASION
ENAMELOPLASTY - COSMETIC RECONTOURING
ROOT CANALS
ORAL SURGERY & EXTRACTIONS
TMJ/TMD DISORDERS
SEALANTS
PERIODONTAL DISEASE THERAPY
ORAL CANCER SCREENINGS
PEDIATRIC DENTISTRY
DENTURES - COMPLETE, PARTIAL, & IMPLANT