5301 South Lewis Ave. - Tulsa, OK 74105 - 918.742.8100 - info@pearlywhite.com

Rate Your Visit!

This page is for current patients who have had recent treatment but didn't have time to fill out a Service Evaluation form in our office. If you would like to give us your feedback, for better or worse, here's your chance! Please be candid, this is anonymous unless you give us your name.

Date of Service:
If you were kept waiting, how long was your wait?
Did you feel like Dr. Davis gave you his full attention?
Did you feel like the staff gave you their full attention?
Did anything hurt while you were here?	Yes No
If so, what hurt?
Was the office atmosphere pleasant?
If not, was it any of the following?
Was your treatment explained to your satisfaction?
Were financial matters explained to your satisfaction?
Based on your visit here, would you refer other people to this office?
Was there any one staff member or the Dr. you would like to comment on, either positively or negatively?
How can we improve?
What do you want us to continue doing?
Other Comments:
Your name if you want us to know it:
Email address if you want Dr. to respond:

Thank you for helping us do our best!

Mark M. Davis, D.D.S.
5301 South Lewis Ave.
Tulsa, OK 74105
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Phone
918-602-4648

Fax
918-858-1049

Request an Appointment:

Patient Forms

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Patient Information Forms

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