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Patient Experience Survey

Deborah Anders Located at 3094 U.S. 70 Highway, Black Mountain, North Carolina 28711
Phone: (828) 634-4111 www.smileinblackmountain.com

1.	Were your dental concerns addressed to your satisfaction?	Yes No
2.	Was your overall experience what you expected?	Yes No
3.	Would you recommend our office to a friend, co-worker or family member?	Yes No
4.	Do you feel that your treatment needs were explained adequately?	Yes No
5.	Did our financial options allow you to recive all the dental care you needed?	Yes No
6.	Do you have additional comments?


*	I authorize and understand that my information above may be used for testimonials and connection with advertising and promoting our Dental Practice. I agree that I will make no monetary or other claim against Deborah Anders, DDS, PA for the use of this statement.