Patient Survey

Our goal at Stone Oak Orthodontics is to meet and surpass the expectations of all our patients and their families. It is only through your feedback that we can both enjoy our success and work to improve areas that need attention. Thank you for taking the time to answer these few questions on this important day as orthodontic treatment is complete. We very much appreciate your sincere comments.

Please check your form to make sure it is complete and press the submit button when you are done. Thanks for your future referrals!

	Your Expectations
Please think back to your initial new patient evaluation. Was it professional, informative, timely and organized?	AboveMetBelow
Our goal is for our staff to always be professional yet friendly. Were they?	AboveMetBelow
At every appointment we attempted to keep you informed as to the progress of treatment. How was our communication?	AboveMetBelow
Our clinical team is trained to be as gentle as possible during procedures. Did we accomplish that?	AboveMetBelow
We attempt to keep our facility attractive, clean and comfortable for patients and parents. Was it?	AboveMetBelow
We realize that orthodontic treatment is a substantial financial investment. Did our financial options accommodate your needs?	AboveMetBelow
We want our front desk staff to make patients and parents feel welcomed and important at every visit. Did they accomplish that?	AboveMetBelow
We try to work with our patients to schedule as many of their appointments as possible at convenient times. How did we accommodate your schedule?	AboveMetBelow
As important as customer service, professionalism, etc. is to us, the bottom line is that we want you to be pleased with our results. How did we do?	AboveMetBelow

Assistant who assisted Dr. Norris with your Debond?

If at any time during treatment you had a negative experience with our practice or our staff, we would appreciate you giving us a brief explanation of the situation so that we might work to insure it does not happen in the future:

We would like to share any positive comments you might have about us with our staff and other potential patients. Below, feel free to share any positive feedback that we may share with others:

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Patient Name:

Patient Email:

May we quote you?

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* You should not send sensitive or confidential information to us through this form, as such information will not necessarily be considered privileged or confidential. If you are a current patient of Stone Oak Orthodontics, please check with us regarding the best means of communicating your confidential information to us.