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777 W. Broadway Suit 700
Vancouver V5Z 4J7
British Columbia
Canada
Tel 604-872-8201
Fax 604-872-8242
Email Us

Patient Survey form for Broadway Dental patients

About Us | About Office | Our Services | Appointments | Financial Options 

 patientSurvey.jpg

re_20.jpgWe appreciate you taking the time to complete our survey. We take your comments seriously. Any comments you choose to make are kept strictly confidential and can only help us become better in the future. 

 

 

User Information

Name : Email Address :

Overall Service

Staff Friendliness

Seated and Seen on time?

 Yes
 No

Front Desk Service

Care received from hygienists?

Care received from Dr. Niktash?

Care received from Dr. Iranpour?

Recommen our office to friends and family?

Did any of the staff make your visit special or difficult?

 Yes
 No

Please describe your experience

Please comment on new services you would like to see

Do you mind to be contacted regarding the survey?

 Yes
 No
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