Patient Info > Patient Forms

Patient Online Survey

This online survey is designed to help us enhance our quality of orthodontics services. We highly appreciate your feedbacks and suggestions.

How would you rate your overall service experience with our practice?
Excellent	Good	Fair	Poor

Please rate the following criteria (scale of 1 to 5 with 5 being the highest quality)

			1	2	3	4	5
Telephone demeanor of staff
Greeted promptly upon entering the office
Team ready and eager to assist you
Wait time to be seated for appointment
Staff provided quality, attentive care
Staff knowledgeable answered all my concerns
Doctor was sensitive and attentive
Doctor fully explained treatment options
Doctor answered all my questions

Would you recommend us to your friends, family, and colleagues?
Yes	No	Don’t Know

What is the reason for previous ranking?


How can we improve you orthodontic experience?

CAPTCHA Image

Enter above code:

Note: Letters are case-sensitive

Please call us at (310) 444-1113 or send an email to schedule your free initial consultation. We serve Southern California including Los Angeles (LA), Beverly Hills, and Santa Monica.

We look forward to hearing from you!