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Patient Feedback Form

Feedback Form:

If “Other”, please specify

On a scale of 1 through 5, 1 being the lowest rating and 5 being the highest rating…

How would you rate the standard of cleanliness and hygiene at the dental clinic?
Not Clean    1    2    3    4    5   Very Clean

How satisfied are you with your experience at this clinic?
Not Satisfied    1    2    3    4    5   Very Satisfied

How likely is it that you would recommend the dental practice to a friend or colleague?
Not Likely    1    2    3    4    5   Very Likely

How likely is it that you would recommend Beyond Borders Dental to a friend or colleague?
Not Likely    1    2    3    4    5   Very Likely

Please estimate how much money have you saved by using our approved clinic?
$

Please share any comments about the doctors, your experience here and your recommendations to others:

May we use your comments? Yes    No

May we use your first name and last name initial, your city, state? Yes    No

Please tell us anything that could be improved about your dental concierge services.

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54-A Avenida Aldea, Santa Fe, NM 87507 Phone 1-505-738-7770 Hours Monday - Friday, 9:00 AM - 5:00 PM MDT
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