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Patient Survey

We appreciate you taking the time to complete our satisfaction survey regarding your last visit to Roca Dental. Any comments you choose to leave will be kept strictly confidential and are used only to help us serve you better.

Which Doctor served you today?
 Dr. Aurelio A. Roca Dr. Adam J. Roca
What procedue did you have done?
 Cleaning/Checkup Fillings Crown Root Canal Other
How would you rate your overall visit?
 Excellent Very Good Average Not so good
When your appointment was over did you have a good understanding of your dental situation?
 Yes Not Really I wish i knew more about my situation
Were your financial options explained to you?
 Yes No I already understand my financial options
Did you wait over 15 minutes past your appointment time to be seated? If yes, how long?
 No 15 minutes 15-30 minutes 30-45 minutes Over 45 minutes
Did the staff greet you promptly?
 Yes Not Really I don't recall
Would you refer your friends and family to us?
 Yes No I'm not sure
What, if any improvements could we do to better your visit?

Any other comments/concerns regarding your visit?