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Patient survey

We enjoy having you as a patient and remain committed to serving you as completely as possible. That’s why we would appreciate your suggestions and comments about your Apple experience. Please fill out this form and click the SUBMIT button to send us your comments. Due to privacy considerations, please don’t include sensitive or personal information.

1. Were you pleased with our scheduling system and the general flow of your appointment?

Very Satisfied Satisfied Not Satisfied 

If not satisfied, please explain.

Do you think our doctor and team explained your treatment, gave clear instructions and answered your questions?

Very Satisfied Satisfied Not Satisfied 

If not satisfied, please explain.

3. Was our team ready and eager to assist you?

Very Satisfied Satisfied Not Satisfied 

If not satisfied, please explain.

4. Are there any areas in which our service could be improved?

Yes No 

If yes, please explain:

5. Would you recommend Apple Orthodontix to your family and friends based on today’s appointment?

Yes No 

If not, please explain:

6. What you think matters to us. Please tell us about your Apple experience.

Which Apple office do you go to?

Name (Optional)

Email (Optional)

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Thank you very much for your feedback.

© 2013 Apple Orthodontix | 840 Central Parkway East, Suite 100 | Plano, Texas 75074 | 1-888-611-APPLE