We want to improve your experience with us. 

As an office that is committed to excellent customer service, we value your opinion.  It is our greatest pleasure to have you as a patient.  Please answer these quick questions so we can continue to improve our services for you.  In appreciation for you taking the time to complete this survey, your name will be entered in a drawing for a chance to WIN a prize.  Click here for prize details and previous winners. If you don't feel comfortable leaving your name or you just wish to leave feedback without wanting the prize, you can be entered as anonymous and if that name is drawn then the cash equivalent of the prize ($100) will be donated to the Oklahoma Dental Foundation.

Name:  
Phone:  
Email:  

 

 

 

 

 

 

 

1. Were you greeted promptly and courteously?

    

     1. Unacceptable     2. Poor      3. Fair     4. Good    5. Excellent

 

2. Was the office environment clean and professional?
    

     1. Unacceptable     2. Poor      3. Fair     4. Good    5. Excellent

 

3. How long was your wait?

     1. Less than 5 min

     2. 5-10 min

     3. More than 10 min

 

4. Were your dental concerns and questions addressed?

    
     1. Unacceptable     2. Poor      3. Fair     4. Good    5. Excellent

 

5. Was your treatment thoroughly explained with alternative treatment options offered?

   

     1. Unacceptable     2. Poor      3. Fair     4. Good    5. Excellent

    

6. Did the clinical team, including Dr. Beasley, keep you informed and comfortable throughout the procedure?

   

     1. Unacceptable     2. Poor      3. Fair     4. Good    5. Excellent

 

7. Did the front desk assist you in all insurance, payment, and scheduling questions?

    

     1. Unacceptable     2. Poor      3. Fair     4. Good    5. Excellent

 

8. Did anyone provide you with outstanding service? 

    No                         Yes, I was pleased with

9. Would you recomend our office to others? 

    1. Definitely Would     2. Definitely Would Not     3. Uncertain

Specific Comments: 

 

Please note that comments may be used as a patient testimonial.

Justin L Beasley DDS
4600 W Memorial Rd
Oklahoma City, OK 73142
(405) 755-5400