9099 Katy Freeway ~ Suite 180 ~ Houston, TX 77024
713.932.0441
  
 

 

Patient Survey

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

How would you rate your overall visit?
Excellent Very Good Average Not so good

When your appointment was over did you have a good understanding of your dental situation?
Yes Not really I wish I knew more about my situation

Were your financial options explained to you?
Yes No I already understand my financial options

Did you have to wait over 15 minutes past your appointment time to be seated? If so how long?
No 15 to 30 minutes 30 to 45 minutes Over 45 minutes

Did the staff greet you properly?
Yes Not really I don't recall

Would you refer your friends and family to us?
Yes No I'm not sure

Would you like to talk to Dr. Schleicher about your care?
Yes No

Please comment on how we could make your visit better, new services you would like to see, or other ways we can make you feel more comfortable.
  • INIVISALIGN
    Straighten your smile in a more comfortable way.
  • LUMINEERS
    Make the Most of Your Smile with Minimal Reduction.
  • HEADACHES
    Oral appliance therapy can be very effective in many headache situations.
  • TEETH WHITENING
    Whitening is a simple, safe way to brighten your smile.
  • TMJ TREATMENT
    If you have freguent headaches, facial pain, or neck pain; we can help.
  • IMPLANTS
    If you're missing one o more teeth, dental implants offer a natural-looking solution.
  • NTI
    NTI Device Takes the Bite Out of Pain.
     

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