Patient Satisfaction Survey
ASO routinely monitors patient satisfaction as part of its continuing evaluation of each dentist's professional services, and also to assure that Fund members are treated in a friendly congenial office atmosphere. Patient impressions are invaluable in this effort, and we ask your help by completing this survey.

Please Enter a Claim Reference # if you have one your Zip Code and click
Dentist Name:	Location:
Please rate the care that you received:	ExcellentGoodFairPoor
Please rate the general office environment:	ExcellentGoodFairPoor
Were you offered convenient appointments?	AlwaysOftenRarelyNever
Were appointments kept promptly?	AlwaysOftenRarelyNever
Were you given a thorough explanation of your treatment options?	YesNo
Was the office staff courteous and competent?	YesNo
How many years have you been a patient of this office?
Would you recommend this dentist to others?	YesNo
Did you incur any charges?	YesNo
If you did, how much and for what?
Your comments and suggestions, please.	Your Name (Optional): Telephone Number: Email Address: