Patient Survey

We are very interested in your feedback, so please fill out the form and let us know what you think of our dental services.

1) How would you rate your overall visit?

2) When your appointment was over did you have a good understanding of your dental situation?

3) Were your financial options explained to you?

4) Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?

5) Did the staff greet you properly?

6) Would you refer your friends and family to us?

Please comment on how we could make your next visit better, new services you would like to see, or other ways we can make you feel more comfortable.

Your Name:(optional)

Email Address:(optional)

Affinity Dental, PLLC
1735 N Story Rd #180
Irving, TX 75061
(972) 513-9000
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