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Quick Survey

We are always interested to learn more about what is valued in a dentist and a good dental office. Any information you provide will be kept strictly confidential. Please let us know your opinions below:

What brings you to our site today?

Is there a particular dental problem or topic you are wanting to find out about?

Afraid of The Dentist Cost of dentistry Need a family dentist Whitening Cosmetic dentistry such as veneers Bad breath Bleeding gums Pain or sensitivity Restorative dentistry such as crowns, bridges or implants Dentures Sleep problems

What positive experiences, if any, have you had with a dentist?

Any experiences that were negative?

What positive or negative experiences have you had with the staff of a dental office?

What are the biggest barriers to visiting the dentist?

Do you regularly see a dentist now?

-Select an Option- Yes No

If not, how would you most likely go about finding one?

Direct Mail (Newsletters, Postcards, Letters) Coupons Directories (Yellow Pages) TV Radio Newspaper Magazine Internet Search Engine Referral from family or friends Referral from a Dentist or Physician

Do you have dental insurance at present?

-Select an Option- Yes No

If yes, are you happy with your insurance coverage?

-Select an Option- Yes No N/A

Your Gender?

-Select an Option- Male Female

Your approximate age?

-Select an Option- 18-30 31-40 51-60 61-70 71+

If you would like us to contact you, please provide an email address or a phone number with best time to reach you.