Survey

Please choose one of the options for each of the following questions:

Who Filled Out This Survey?

Patient
Parent of Patient

Your OFFICE is:

Very Easy to Find
Not Too Difficult to Find
Difficult to find

The Overall ATMOSPHERE In Your Office Is:

Warm and Inviting
Pleasant to be in
Uneasy and Intimidating

When PHONING THE OFFICE I AM usually TREATED:

With Prompt, Courteous Attention
Pleasantly
Indifferently or On Hold A Lot
Rudely or Abruptly

The Person ANSWERING the Phone USUALLY is:

Well Informed and Helpful
Somewhat Helpful
Unable to Fulfill My Needs 

When Entering The Office The RECEPTIONIST Treats Us:

With Utmost Courtesy, Warmth & Attention
Pleasantly and Courteously
Indifferently
Coldly

The Overall OFFICE CLEANLINESS is:

Always Clean
Usually Clean
Rarely Clean

FINANCIAL SERVICE RECEIVED THUS FAR:

Our FINANCIAL ARRANGEMENT For Your FEE Was:

Acceptable and Met My Needs
Reasonable and Acceptable
Barely Acceptable
Too Rigid or Too Inflexible

Your Help With Our INSURANCE Processing Was:

Fast and Accurate
Reasonable and Acceptable
Within a Reasonable Period to Wait
Done Poorly and/or Inaccurately

When I Inquired About My Account You Were:

Fast and Accurate
Timely and Helpful
Not Totally Satisfactory
Inaccurate or Inept

COMMUNICATIONS and SCHEDULING:

In General, I Find The COMMUNICATIONS At The New Patient Evaluation Visit 
And Case Presentation Visit and All Communications Thus Far To Be:

ALL That I Wanted TO Know
MOST of What I Wanted To Know
SOME of What I Wanted To Know
LITTLE of What I Wanted To Know

When Things Were Explained To Me THey Were:

THOROUGHLY Understandable
Fairly Understandable
Difficult to Understand
Usually Inconvenient

When SCHEDULING APPOINTMENTS I Find the Availability of Appointments To Be:

Always Convenient
Usually Convenient
Sometimes Inconvenient
Usually Inconvenient

IN GENERAL, My Scheduled Appointments are Started and Completed:

Always On Time
Usually On Time
Usually Running Late
Always Running Late

QUALITY OF TREATMENT RECEIVED THUS FAR:

I Feel That The Quality of Orthodontic Treatment I Am Receiving Is:

Excellent
Good
Satisfactory
Unsatisfactory

The DOCTOR Treated Me and/or My Child:

In a Warm, Friendly Yet Professional Manner
In a Cordial Professional Manner
Indifferently
Coldly

The CLINICAL STAFF Treated Me and/or My Child:

In a Warm, Friendly Yet Professional Manner
In a Cordial Professional Manner
Indifferently
Coldly

If A Problem Arose in Treatment, The Doctor Took Care of It:

Immediately, at Our Convenience
Within a Reasonable Period of Time
With Some Delay or Inconvenience
In an Unacceptable Manner

If An EMERGENCY Arose in Treatment, The STAFF Handled It:

Immediately, at Our Convenience
Within a Reasonable Period of Time
With Some Delay or Inconvenience
In an Unacceptable Manner

When We NEEDED To TALK to The DOCTOR, The Doctor Was:

Always Accessible and Helpful
Usually Accessible and Helpful
Sometimes Unavailable
Usually UNavailable and NOT Helpful

When We NEEDED Help From The CLINICAL STAFF, The Staff Were:

Always Accessible and Helpful
Usually Accessible and Helpful
Sometimes Unavailable
Usually UNavailable and NOT Helpful

My Main Reason For Selecting Your Practice Was:

Referral From a Family Member Treated Here
Referral From Another Patient Treated Here
Referral by Family Dentist
We Found You in The Yellow Pages
We Find Your Location Convenient

Based On My Or My Family's Experience With Your Office Thus, Would I Recommend
Your Office To Friends And Relatives Who May Need Orthodontic Treatment?

We Would and/or Already Have
We Would Without Hesitation
We Would With Some Reservations
We Would NOT Recommend You