Survey Page

Patient Feedback

Help us build the smile experience you deserve

Your honest feedback helps us grow, improve, and show up in all the right places for you.

⏱ About 4–5 minutes

* All Question Required

How You Found Us

How did you first hear about Smile House?

Select one

What made you decide to book your first appointment?

Select one

Before booking, did you look us up online?

Your Experience

Is there anything about your experience you think we could improve?

What would make your visits even better or more helpful? (Optional)

Think: reminders, communication, services, anything

Are there any services you wish we offered, or didn't know we had? (Optional)

Loyalty & Referrals

What would make you MORE likely to refer someone?

Select all that apply

Have you left us a review on Google?

Yes

No, but I'd be willing to

Where You Want to See Us

Where do you want to see more of Smile House?

Select all that apply

What kind of content would you find most helpful from us?

Select all that apply

How do you prefer we communicate with you between appointments?

About You

How long have you been a patient at Smile House?

This is my first visit

Less than 1 year

1–3 years

3+ years

What’s your Zip code?

Help us understood where our patients come from

What’s your age range?

Where would you like to see a second Smile House Location?

Be as specific as you like neighbourhood, Borough, city, or zip

What best describes your household?

Single

Couple, no kids

Family with kids

Prefer not to say

What’s your primary reason for coming to Smile House?

Select one

How do you cover the cost of your dental care?

Insurance (in-network)

Insurance (out-of-network)

Self-pay (no insurance)

What industry do you work in?

That's it, thank you so much! Your feedback helps us build something truly special for our community.

"Thank you for your inquiry.
Our care team will contact you soon."

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