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Post-Appointment Survey

We appreciate you choosing our practice, and we are committed to making sure that your time spent with us is as comfortable and fulfilling as possible. In order to continue providing the kind of care that keeps our patients smiling, we encourage your comments and suggestions about the treatments and personal care you've received while visiting our practice.

Please take a moment to provide us with your feedback. When you're finished, click on the SUBMIT button at the bottom of the page.

Please tell us about your appointment:

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How would you rate your overall experience?


 
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Would you like a member of our team to contact you to further discuss your experience?

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COSMETIC AND IMPLANT DENTISTRY IS NOT RECOGNIZED AS A SPECIALTY AREA BY THE AMERICAN DENTAL ASSOCIATION OR THE FLORIDA BOARD OF DENTISTRY. THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE PAY. CANCEL PAYMENT, OR BE REIMBURSED FOR OTHER SERVICES, AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE EXAMINATION, OR TREATMENT. NOT VALID WITH OTHER OFFERS OR 3RD PARTY PAYMENT. OFFER VALID FOR CARD HOLDER. OFFER HAS NO CASH VALUE. GENERAL DENTIST LICENSE #DN18196, PAUL ULIASZ | 3448 CLEVELAND AVENUE | FORT MYERS, FL 33901 | (239) 201-2571. THE FEE IS MINIMUM FEE. LIMITED TIME OFFER. HOURS BY APPOINTMENT.
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