Treatment Started Questionnaire

Please indicate below whether you agree or disagree with each statement. Please use the following scale:

1. Was Dr. Tadej open, honest, and thorough in answering you or your child’s questions?
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2. Do you feel you/ your child received adequate personal attention from Dr. Tadej and Staff?
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3. Did the physical environment of the office meet your expectations?
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4. Do you feel that Dr. Tadej and our staff really care?
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5. Were you/ your child seen on time?
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6. Do you feel the scheduling, billing, and other office systems are user friendly?
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7. Did you/ your child feel you received fair value for the orthodontic fee?
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8. Would you refer other patients to our practice?
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9. What do you like best about our office?

10. What do you like least about our office?

11. Where do you think we need improvement?

12. What was the main factor that caused you to decide to have treatment with our office?

13. Please add additional comments that would help us serve you and others.

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