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Thank you for visiting Smile Sensations. We hope you were impressed by our service and that you feel confident in recommending Smile Sensations to friends and relatives in the future. You can trust we will listen to your feedback and make changes when appropriate.

Please fill out the Smile Sensations survey below, and submit it in one of three ways:

1) Complete this online form, press the submit button.

2) Fax to (203) 324-9633

3) Download, complete and mail or deliver your survey to:

Smile Sensations Patient Survey
60 Strawberry Hill Avenue, Ste L-2
Stamford, CT 06902

Please call if you have questions about the survey
(203) 323-9277

Patient Survey Help us serve you better!

Purpose of Visit:

Please Rate the Following:

Name of Specialist:

Comments and Testimonial (optional):

Please include any comments below. We invite you to write a brief testimonial. You might include the reason for your visit, the ease of the scheduling process, your impressions of the office and staff, your satisfaction with the service you received, and how it helped fulfill the initial need that brought you to the practice.

May we use your testimonial in our marketing (includes but is not limited to website, printed material, commercials)?

Please add further description here:

Tell us how to get in touch with you:

Name
E-mail
Tel
FAX

Please contact me as soon as possible regarding this matter.

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