Post-Appointment Survey

We appreciate you choosing our practice, and we are committed to making sure that your time spent with us is as comfortable and fulfilling as possible. In order to continue providing the kind of care that keeps our patients smiling, we encourage your comments and suggestions about the treatments and personal care you’ve received while visiting our practice.

Please take a moment to provide us with your feedback. When you’re finished, click on the SUBMIT button at the bottom of the page.

You can also visit us on Google from your phone or go to our new website RUBIN ORTHODONTICS and scroll down and write a review about your office experience and make sure to visit our facebook page and add your comment under REVIEWS.

LOOKING FORWARD TO HEARING FROM YOU

**Stephanie –* PATIENT COORDINATOR

Please tell us about your appointment

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Please tell us about your appointment

Please describe your experience visiting our practice.

Please describe your experience working with the doctor(s) and staff.

What was your favorite thing about being at our practice?

What areas could we improve upon to make your experience even more enjoyable?

How would you rate your overall experience?

Poor

Average

Good

Great!

Please provide any additional comments/suggestions.

Contact Information

Would you like a member of our team to contact you to further discuss your experience?*

Please provide your name and email address

Your Name

First and Last

Your Email Address

*Stephanie – PATIENT COORDINATOR

Please tell us about your appointment

Please tell us about your appointment

Contact Information

Please provide your name and email address

**Stephanie –* PATIENT COORDINATOR