Fort Lauderdale Dentist - Patient Survey - General and Cosmetic Dentistry

Fort Lauderdale Dentist, Dr. Jeff Bartlett, offers expert cosmetic dentistry, Invisalign, laser dentistry, dental implants and Zoom whitening.

2440 East Sunrise Blvd. Ft. Lauderdale, FL. 33304 (inside the Galleria Mall - between the Gap and Dillards on the back side)

(954) 566-8668

	WELCOME
	MEET DR. BARTLETT
	SMILE GALLERY
	OUR TEAM
	OUR SERVICES
	COSMETIC ANALYSIS
	ANXIETY-FREE DENTISTRY
	ZOOM WHITENING
	LASER DENTISTRY
	ADVANCED TECHNOLOGY
	PATIENT PAMPERING
	PERMANENT MAKEUP
	HOURS & LOCATION
	FINANCE OPTIONS
	APPOINTMENT REQUEST
	PATIENT FORMS
	PATIENT SURVEY
	CONTACT US
	HELPFUL LINKS

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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.


Patient Name :
E-mail Address :
Date of your last visit:
How was the treatment you received :
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.: Please enter code above in the field below.

Appointment Request Ft. Lauderdale Dentist

New Patient Offer

FREE Whitening
for Life!

Receive a complimentary whitening kit and custom trays with completed new patient exam, cleaning, and x-rays. Keep your 6-month recare visits and you will receive additional gel annually for the rest of your life! ACT NOW to take advantage of this amazing offer, simply complete the form provided and click on send info. Thank you.

<table border="0" cellspacing="3" cellpadding="3" align="center"> <tbody> <tr> <td> <p style="text-align: center;"><strong><span style="font-size: medium; color: #ff0000;"><em>New Patient Offer</em></span></strong></p> <p style="text-align: center;"><strong><span style="font-size: small;">FREE Whitening <br />for Life!</span></strong></p> <p>Receive a complimentary whitening kit and custom trays with completed new patient exam, cleaning, and x-rays. Keep your 6-month recare visits and you will receive additional gel annually for the rest of your life! ACT NOW to take advantage of this amazing offer, simply complete the form provided and click on send info. Thank you.</p> </td> </tr> </tbody> </table>
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Ft. Lauderdale Dentist · Jeff Bartlet DDS · 2440 East Sunrise Blvd · Ft. Lauderdale, FL · 33304