Evaluation Card Baytown

M.T. Tabrizi ProDental P.C.

To help us provide our patients with the best possible care, please take a moment to answer the following questions about your visit to our office. (Circle the most accurate response for each question.)

Your Name (optional)

* E-mail address

1. Did you receive prompt, courteous attention when you called for an appointment?
Yes No Somewhat

2. Were all members of this office staff friendly and courteous?
Yes No Somewhat
Staff Name (optional)

3. Did the office and the doctor put you at ease?
Yes No Somewhat

4. Were you provided with adequate responses to your questions about treatment?
Yes No Somewhat

5. The things you liked the most about this practice were:

6. The things you most disliked about this practice were:

7. Would you refer your friends and family to us?
Yes No

* Required

Be sure to return for
your follow-up appointments.