How Was Your Experience at Elice Dental Care?

We are very interested in your feedback, so please fill out the form and let us know what you think of our dental services.

How would you rate your overall visit?(Required)

Excellent	Very Good	Average	Not Good

When your appointment was over did you have a good understanding of your dental situation?(Required)

Yes

I wish I knew more about my situation

Were your financial options explained to you?(Required)

Yes

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?(Required)

Yes

I do not recall

Would you refer your friends and family to us?(Required)

Yes

I am not sure

Name(Required)

First Last

Email(Required)

Phone

Message

Comments

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