Post-Appointment Survey

Our goal is to ensure that your experience in working with our office is as convenient and pleasant as possible and that your patients are satisfied with their orthodontic experience. We would greatly appreciate any feedback, negative or positive, so we may improve our performance in the future.

Patient Name (Optional)

Parent/Guardian Name (Optional)

Email (Optional)

Phone Number (Optional)

Did the staff and Dr. Willett or Dr. Harre explain your orthodontic treatment options, instructions, and answer your questions thoroughly?
YesNo

Comments:

Were you pleased with our scheduling of your appointments and payment arrangements?
YesNo

Comments:

Are there any areas in which our service could be improved?
YesNo

Comments:

Would you recommend Lincoln Orthodontics to your friends, family, and colleagues?
YesNoI don't know

Comments: