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www.BurlesonOrtho.com
Practice Survey
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1.
On a scale of 1 to 10 (with 10 being excellent and 1 being very poor), please rate the following areas of our practice:
(Required.)
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10
Overall satisfaction with our doctor and staff
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Value (cost) of orthodontic treatment in our office
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10
Physical environment / cleanliness of our facility
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Convenience of appointment times
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Greeting upon arrival
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Telephone demeanor of our staff
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10
2.
When looking for an orthodontist, what was your biggest fear or frustration?
3.
What feature would you like to see added to our office?
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4.
Are you aware that our office is currently accepting new patients?
(Required.)
Yes
No
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5.
Do you feel positive enough about our practice to refer family or friends?
(Required.)
Yes
No
6.
If you would like to receive a courtesy call to discuss any questions, comments or special requests, please provide your e-mail address and best phone number below. Surveys are checked weekly, please allow 5-7 business days for one of our smile specialists to reach you via phone or e-mail. Thank you!