Dental Patient Survey


We care about the level of service that we offer you.  We would be grateful for your feedback as a patient of Kakouras Family Dentistry.  We would like to know what we are doing well and in what areas we need to improve our services to you. 

Please fill out our Patient Survey by clicking on a link below.  Available in a Microsoft Word Document or Adobe PDF Document.  Please mail the survey to our address at 11020 South Tryon Street, Ste 401.  Charlotte, NC 28273.  You may also bring it to your next appointment! 

Patient Survey (Microsoft Word)
Patient Survey (Adobe PDF)

Thank you for helping us improve our services to you,

Kakouras Family Dentistry


This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


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We encourage you to contact us with any questions or comments you may have. Please call our office or use the contact form below.

Healthy Smiles

What does your smile say about you? Let us help you radiate confidence with a healthy smile.