Dr. Willingham and Reiter, D.D.S.

1700 Professional Circle
Yukon, OK 73099
ph: 405-354-4893
fax: 405-350-3283
karenr@coxinet.net

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Patient Survey

It is our hope that you have been pleased with the dental care received from us. It is also our desire to offer you the best of dental treatment in the future. Hopefully, by working together on the PREVENTIVE care of your mouth, we can keep your dental TREATMENT needs to a bare minimum in the future. So we may serve you better, will you please take a minute or two to answer these questions. We would appreciate it!

Thank You!

Thank you for helping us improve our services to you!

Tell Us What You Think

First Name:

Optional

Last Name:

Optional

Email:

Optional

Service Date:

Were you referred to our office?

by another doctor? by another patient? by insurance company? by dental office employee? by website? by phonebook?

Have you referred anyone to us?

Yes No

Would you recommend our services to others?

Yes No

Do you find the office personnel as courteous and concerned as you would like?

Front office- Yes Front office- No Doctors/Assistants/Hygienists- Yes Doctors/Assistants/Hygienists- No

Add comments below.

Were the office and treatment procedures explained clearly and to your satisfaction?

Yes No

Add comments below.

Do you feel "at home" in the office and free to ask any question either about financial arrangements or treatment procedures?

Yes No

Add comments below.

Do you have any suggestions for improving our service in the future?

Yes No

Add comments below.

Please add comments below.

Thank you!

Submit Your Message:

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1700 Professional Circle
Yukon, OK 73099
ph: 405-354-4893
fax: 405-350-3283
karenr@coxinet.net