1. Who referred you to Colorado Endodontic Specialists, Inc.?

General Dentist
Friends/Relatives
Other Health Care Professional
Internet
Your Insurance Carrier
Yellow Pages
Other

2. How was your initial contact with a staff member?

Poor
Satisfactory
Good
Exceeded Expectation

3. Was the interior and temperature of the office comfortable?

YES
NO

4. Was there a staff member to greet you?

YES
NO

5. Were your documents processed appropriately/timely?

YES
NO

6. Were your questions answered either by Dr. Macaraeg or our staff to your satisfaction?

YES
NO

7. Overall, would you refer our office to others?

YES
NO

Additional comments/suggestions:

Name