Patient Survey

Thank you for your feedback. It helps us to ensure we're providing the finest orthodontic and customer service for you and your family.

1. Please comment on the appearance/impression of the following areas:
Please use the following scale for your responses:
1. Very Poor   2. Poor    3. Average    4. Good   5. Very Good  

		Comments
Waiting room	1 2 3 4 5
Reception desk	1 2 3 4 5
Treatment rooms	1 2 3 4 5
Consultation room	1 2 3 4 5
Please feel free to list specific staff names. 2. Please rate on the appearance and professionalism of the front desk team.
1 2 3 4 5
3. Please comment on your observation as it pertains to the front desk team (specific team names will be helpful)
4. Please rate on the appearance and professionalism of the orthodontic assistants
1 2 3 4 5
5. Please relate your observation as it pertains to the orthodontic assistants (specific team names will be helpful)
6. Please relate your observation as it pertains to Dr. Seuss
1 2 3 4 5 | Comments:
7. Please rate on the effectiveness of the appointment phone text/call, email, reminder system
1 2 3 4 5 | Comments:
8. Have you visited both of the office locations ?
5 YES 5 NO
9. Did you know that you could register online to gain access to your personal account information?
5 YES 5 NO
10. How satisfied are you with the availability of appointment times?
1 2 3 4 5 | Comments:
11. How do we rate with regards to keeping on time for your scheduled appointments?
1 2 3 4 5 | Comments:
12. If you needed extra assistance with treatment (emergency appointment), how would you rate the response of the Doctor and/or team?
1 2 3 4 5 N/A | Comments:
13. How would you rate the way in which the treatment plan was explained to you?
1 2 3 4 5 | Comments:
14. How satisfied were you with our policy on financial arrangements?
1 2 3 4 5 | Comments:
15. Based on your experience, how likely are you to recommend our office to family or friends who need orthodontic treatment?
Would Recommend Unsure Would Not Recommend
16. Final Comments
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