Ft. Lauderdale Dentist

   
Ft. Lauderdale Dentist
 

 
  Patient Survey
       

Please take a moment to complete our survey.  Your comments are welcome and completely confidential. Your input will help us improve our service.  Thank you.

We appreciate you taking the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us become better in the future.

Patient Name :
E-mail Address :
Date of your last visit:
How was the treatment you received :
How comfortable were you during the treatment you received :
Was your treatment explained to you so that you have a clear understanding of your dental situation :
Were your financial options explained to you? :
How long did you wait before being seated in a room?
Would you refer your friends and family to us? :
Please comment below on how we could make your next visit better and more comfortable.  Thank you.:


 
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Ft. Lauderdale Dentist
Ft. Lauderdale Dentist

New Patient Offer

FREE Whitening
for Life!

Receive a complimentary whitening kit and custom trays with completed new patient exam, cleaning, and x-rays. Keep your 6-month recare visits and you will receive additional gel annually for the rest of your life! ACT NOW to take advantage of this amazing offer, simply complete the form provided and click on send info. Thank you.


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Fort Lauderdale Dentist · Dr. Jeff Bartlett DDS · 2440 East Sunrise Blvd · Fort Lauderdale, FL · (954)566-8668