Patient Survey

We are very interested in your feedback, so please fill out the form and let us know what you think of our dental services.  Please do not send sensitive data using this form.

Patient's Name:  (optional)
Email Address:  (optional)
  1. How would you rate your overall visit?
    Excellent Very Good Average Not so good
  2. When your appointment was over did you have a good understanding of your dental situation?
    Yes Not really I wish I knew more about my situation
  3. Were your financial options explained to you?
    Yes No I already understand my financial options
  4. 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
  5. Did the staff greet you properly?
    Yes Not really I don't recall
  6. Would you refer your friends and family to us?
    Yes No I'm not sure
  7. Please comment on how we could make your visit better, new services you would like to see, or other ways we can make you feel more comfortable.

Laurie Deemer, DMD
2104 Newton Drive, NE
Covington, GA 30014
Get Directions
Phone: (770) 787-2828
Fax: (770) 786-2167
Office Hours:

Mon 8:00am - 5:00pm
Tues 8:00am - 5:00pm
Wed 8:00am - 5:00pm
Thur 8:00am - 5:00pm