Feedback

We at Alpharetta Orthodontics appreciate your business and want you to be satisfied with every aspect of your treatment. Realizing that we do so much with our mouth (speaking, smiling, eating, etc.), we recognize that our success in serving you can be a significant factor in your overall satisfaction in life.

Our highest priority, every day, is to provide our patients with consistently superior service. If we have failed to serve you properly in any way or simply have not measured up to your expectations, we would like to know.

This questionnaire is intended to help us evaluate our performance, especially in cases where we might have fallen short for some reason. Please take a moment at your convenience to rate our effort.

Thank you for giving us the opportunity to serve you.

Initial Visit	Excellent	Good	Fair	Needs Work
Introduction to Office
Interview
Doctor's Exam
Financial Discussions
Questions Answered

Reception Areas	Excellent	Good	Fair	Needs Work
Telephone Calls
Staff Hospitality
Areas Neat and Clean
Insurance Handling
Special Requests

Treatment Areas	Excellent	Good	Fair	Needs Work
Care and Empathy
Courtesy and Response
Helpfulness
Competence/Knowledge
Cleanliness

General Comments	Excellent	Good	Fair	Needs Work
Professionalism
Personal Comforts
Office Atmosphere

	Emphatic Yes	Yes	Okay	No	Never
Would you recommend our service to others?

We are committed to excellence. We can only improve if we know where we need improvement. Please tell us how we can achieve a more "excellent" status.
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