
	10230 Ford Ave, Park Place, Richmond Hill, GA 31324

Hours & Location \| Cosmetic Analysis \| Patient Survey \| Contact Us		Call: 912-756-2936
		Connect With Us:

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 (optional):
E-mail Address (optional):
Date of your last visit (optional):
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.: Please enter code above in the field below.

New Patient Offer

Are You in Pain?
FREE Limited Exam
and X-Ray with Recommended Treatment.

Receive 25% OFF
Brite Smile
with your Initial Exam!

Offer Expires: 05/24/2012

Simply complete the form below.

Patient Survey

Copenhaver Dental · 10230 Ford Avenue - Park Place · Richmond Hill, GA · 31324