Feedback and Testimonials

At Highland Park Dental we are always trying to improve so that we can provide the best service possible. We'd appreciate any feedback to keep us as to what makes us a great dental office as well as what would make us an even better office. Please feel free to fill out the forms below and thank you for your support.

Testimonials

Customer Satisfaction Survey

When you telephone to make an appointment, is the staff member with whom you speak courteous and helpful finding you a suitable appointment time?
When you come to our office for an appointment, does the receptionist give you a friendly greeting and help make you comfortable in the reception area?
How long do you usually have to wait in the reception area before an appointment with the dentist?
How long do you usually have to wait in the reception area before an appointment with the dental hygienist?
Does the dentist take adequate time to explain your treatment and answer your questions?
Are you happy with the way the dentist treats you as a patient?

If No, please explain:
Are you happy with the way the dental assistant treats you as a patient?

If No, please explain:
Are you happy with the way the hygienist treats you as a patient?

If No, please explain:

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Appointments: *email required

Step 1 How many family members need to be seen?

Please provide full names:

Patient 1 Name:

Patient 2 Name:

Patient 3 Name:

Patient 4 Name:

Patient 5 Name:

Step 2

Do you have insurance?

Yes No

Insurance Company Name:

Reason for the visit?

Yes No

Please explain below:

Step 3

Could we get your contact info?

Name:
email*:
phone:
zip: