610 N. Miles St.  •  Elizabethtown, KY 42701                                     Ph: 270-763-6604  •  Fax 270-763-6552   |    E-Mail

Patient Survey

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Derek P. Durbin, D.M.D.
Derek P. Durbin, D.M.D.


Member of:
• American Dental
   Association
• Kentucky Dental
   Association
• Louisville Dental
   Association
• Fellow Intl. Congress
   of Oral Implantologist
• American Academy of Cosmetic Dentistry

Request an Appointment Today!

Office Hours:
Monday - Thursday
8AM  to 5PM

To prequalify for financing, please click on one of the logos below to go directly to their website & to fill out an application.

Please let us know what you think about us!
Bold = Required field
The office is conveniently located.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The reception area is comfortable and attractive.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The office is always clean.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The staff is well-groomed.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The doctor and staff are always courteous.
Strongly Agree
Agree
Neither agree or disagree
Disagree
I am always greeted by someone when I enter the office.
Strongly Agree
Agree
Neither agree or disagree
Disagree
Incoming phone calls are answered promptly.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The doctor and staff show a genuine interest in their patients.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The receptionist is cheerful and cooperative in making appointments.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The doctor and staff are skillful in performing their tasks.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The doctor and staff appear to get along with each other.
Strongly Agree
Agree
Neither agree or disagree
Disagree
I believe I am (my child is) receiving excellent care.
Strongly Agree
Agree
Neither agree or disagree
Disagree
The practice appears organized.
Strongly Agree
Agree
Neither agree or disagree
Disagree
I am normally seen on time.
Strongly Agree
Agree
Neither agree or disagree
Disagree
What do you like best about this office?
What do you like least about this office?
Would you refer any of your friends to our office?
Yes
No
Have you referred anyone to our office?
Yes
No
Additional Comments:
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