Lexington, KY Dentistry  |  Cosmetic Dentistry in Lexington, KY  |  General Dentistry in Lexington, KY
Family and Cosmetic Dentistry Dr Bob Polancich
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Patient Survey
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ServicesInvisalign Invisible Braces
ZOOM Laser Whitening
Dental Implants
Porcelain Crowns & Veneers
Sleep Apnea Treatment
Professional Cleanings
White Fillings

Patient Survey

Please take a moment to complete our survey.  Your comments are welcome and completely confidential. Your input will help us improve our service. Thank you.

We appreciate you taking the time to complete our survey. Please feel free to comment on your visit as well. Any comments you choose to make are kept strictly confidential and can only help us become better in the future.

Please enter your information in the form below:

Patient Name: 

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How comfortable were you during the treatment you received? 

Was your treatment explained to you so that you have a clear understanding of your dental situation? 

Were your financial options explained to you? 

How long did you wait before being seated in a room? 

Would you refer your friends and family to us? 

Please comment below on how we could make your next visit better and more comfortable. Thank you

Home  |  Our Team  |  Smile Gallery  |  Hours & Location  |  Patient Forms  |  Contact Us
Rave Reviews  |  Meet the Doctor  |  Our Mission  |  Payment Options  |  FAQs  |  Oral Cancer Prevention
Cosmetic Analysis  |  Patient Survey  |  Invisalign Invisible Braces  |  ZOOM Laser Whitening  |  Dental Implants
Porcelain Crowns & Veneers  |  Sleep Apnea Treatment  |  Professional Cleanings  |  White Fillings
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