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On-Line
Patient Survey

 

New Patient Form   |   Patient Survey Form

We Accept New Patients and Appreciate Patient Referrals!

Our office, as well as the American Academy of Pediatric Dentistry, recommends that your child visit the dentist by his/her 1st birthday. You can make the first visit to the dentist enjoyable and positive. Your child should be informed of the visit and told that the dentist and their staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better. A parent or legal guardian must accompany the child to the first visit.

It is best if you refrain from using words around your child that might cause unnecessary fear, such as "needle", "shot", "pull", "drill" or "hurt". The office makes a practice of using words that convey the same message, but are pleasant and non-frightening to the child.

If your child is over the age of 3, we ask that you allow them to accompany our staff through the dental experience. We are all highly experienced in helping children overcome anxiety. Separation anxiety is not uncommon in children, so please try not to be concerned if your child exhibits some negative behavior. This is normal and will soon diminish. Studies and experience have shown that most children over the age of 3 react more positively when permitted to experience the dental visit on their own and in an environment designed for children.

We strive to make each and every visit to our office a fun one!

New Patient Form

For your convenience prior to visiting our office, please below here to print the New Patient Health History Form, complete the information and bring it with you to your first visit.

To print the form you will need Adobe Acrobat Reader.  If you do not have Adobe Acrobat, please click here to download it for free to your computer.

 

Patient Survey Form

Patient Name

 

   

How would you rate your overall visit?

  Very Satisfied

 

Satisfied

 

Somewhat Satisfied

 

   

Did the staff treat you professionally on the phone?

Yes
No

 

I do not recall

 

   

Did the staff greet you properly?

Yes

 

No

Comments

 

   

Were the assistants and hygienist's friendly and professional to you and your child?

Yes
No
Comments

 

   

Were the Doctor's professional and courteous to you and your child?

Yes
No

Comments

 

   

Did the appearance and cleanliness of our office meet your expectations?

Yes
No

 

   
Were your financial matters handled in a timely and well addressed manner? Yes
No
     
Would you refer your friends and family to us? Yes
No
     
Please comment on how we could make your visit better...


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Dentistry 4 Children

Lisa Richardson, D.D.S.  ~  Ginger Stagg, D.D.S. 
Freddy R. Cessac, D.D.S., M.S.  
~  Sandhya Harpavat, D.M.D.

Pediatric, Adolescent & Handicapped Dentistry


2 Great Locations - Same Great Doctors!


2015 E. Broadway St., Suite B
Pearland, Texas 77581

E-mail:  dds4children@comcast.net

phone (281) 485-7012      fax (281) 485-3376
Click here for a map to our office

12234 Shadow Creek Pkwy., Bldg 2
Pearland, TX 77584
E-mail: 
dds4children@comcast.net
Phone (713) 436-4669   fax (713) 436-6057
Directions:
We are located 1.2 miles west of Highway 288 on Shadow Creek Parkway. 
After you pass the Hilton Garden Inn on your right we are directly
behind the Sherwin Williams on your left.


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