Exit this survey www.BurlesonOrtho.com Practice Survey Question Title * 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: 1 2 3 4 5 6 7 8 9 10 Overall satisfaction with our doctor and staff Overall satisfaction with our doctor and staff 1 Overall satisfaction with our doctor and staff 2 Overall satisfaction with our doctor and staff 3 Overall satisfaction with our doctor and staff 4 Overall satisfaction with our doctor and staff 5 Overall satisfaction with our doctor and staff 6 Overall satisfaction with our doctor and staff 7 Overall satisfaction with our doctor and staff 8 Overall satisfaction with our doctor and staff 9 Overall satisfaction with our doctor and staff 10 Value (cost) of orthodontic treatment in our office Value (cost) of orthodontic treatment in our office 1 Value (cost) of orthodontic treatment in our office 2 Value (cost) of orthodontic treatment in our office 3 Value (cost) of orthodontic treatment in our office 4 Value (cost) of orthodontic treatment in our office 5 Value (cost) of orthodontic treatment in our office 6 Value (cost) of orthodontic treatment in our office 7 Value (cost) of orthodontic treatment in our office 8 Value (cost) of orthodontic treatment in our office 9 Value (cost) of orthodontic treatment in our office 10 Physical environment / cleanliness of our facility Physical environment / cleanliness of our facility 1 Physical environment / cleanliness of our facility 2 Physical environment / cleanliness of our facility 3 Physical environment / cleanliness of our facility 4 Physical environment / cleanliness of our facility 5 Physical environment / cleanliness of our facility 6 Physical environment / cleanliness of our facility 7 Physical environment / cleanliness of our facility 8 Physical environment / cleanliness of our facility 9 Physical environment / cleanliness of our facility 10 Convenience of appointment times Convenience of appointment times 1 Convenience of appointment times 2 Convenience of appointment times 3 Convenience of appointment times 4 Convenience of appointment times 5 Convenience of appointment times 6 Convenience of appointment times 7 Convenience of appointment times 8 Convenience of appointment times 9 Convenience of appointment times 10 Greeting upon arrival Greeting upon arrival 1 Greeting upon arrival 2 Greeting upon arrival 3 Greeting upon arrival 4 Greeting upon arrival 5 Greeting upon arrival 6 Greeting upon arrival 7 Greeting upon arrival 8 Greeting upon arrival 9 Greeting upon arrival 10 Telephone demeanor of our staff Telephone demeanor of our staff 1 Telephone demeanor of our staff 2 Telephone demeanor of our staff 3 Telephone demeanor of our staff 4 Telephone demeanor of our staff 5 Telephone demeanor of our staff 6 Telephone demeanor of our staff 7 Telephone demeanor of our staff 8 Telephone demeanor of our staff 9 Telephone demeanor of our staff 10 Question Title * 2. When looking for an orthodontist, what was your biggest fear or frustration? Question Title * 3. What feature would you like to see added to our office? Question Title * 4. Are you aware that our office is currently accepting new patients? Yes No Question Title * 5. Do you feel positive enough about our practice to refer family or friends? Yes No Question Title * 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! Done