Patient Survey

We want to hear from you!

As part of our effort to provide the best quality orthodontic care, we are asking you to please take a few minutes to give us your thoughts.

Please choose the answer that best describes your feelings and experiences.

 




Telephone Courtesy

PoorGoodExcellent

Seen on Time

YesNo

Scheduling Appointments

PoorGoodExcellent

Friendliness

PoorGoodExcellent

Care by Dr. Bales

PoorGoodExcellent

Care by Staff

PoorGoodExcellent

Quality of Treatment

PoorGoodExcellent

Was there anyone in our office that made your experience special or difficult?

YesNo

Why?

What else could we do to improve a patient’s experience in our office?

Best method of contact:

EmailTelephone

Name:

E-Mail:

Telephone:

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Member of Canadian Dental AssociationCanadian Association of OrthodontistsMember of American Association of OrthosontistsMember of Manitoba Dental AssociationMember of Toastmasters InternationalRoyal College of District of Canada