*How do you feel about the results of your orthodontic treatment? Choose only one of the following Very Pleased Pleased Somewhat Pleased Disappointed

Do you have any comments about your results?

*How would you rate the performance of Dr. Ross? Choose only one of the following Exceptional Good Average Below Average

*How would you rate the rest of the Ross Orthodontics team? Choose only one of the following Exceptional Good Average Below Average Please rate the rest of our staff (clinical assistants, receptionists, treatment coordinator, etc...)

*Did we stay on time at each visit? Choose only one of the following All of the time Most of the time Sometimes Rarely

If you believe we should change something about our facilities, services, or treatment, please let us know.

What (if any) was the most unpleasant experience you had during our treatment?

*Would you recommend our office to others? Yes No