Patient Survey

We want to hear from you!

As part of our effort to provide the best quality orthodontic care, we are asking you to please take a few minutes to give us your thoughts.

Please choose the answer that best describes your feelings and experiences.

Phone

Telephone Courtesy *

Poor Good Excellent

Scheduling Appointments *

Poor Good Excellent

Care by Dr. Ward *

Poor Good Excellent

Was there anyone in our office that made your experience special or difficult? *

Yes No

Why?

Best method of contact: *

Phone Email

Seen on Time *

Yes No

Friendliness *

Poor Good Excellent

Care by Staff *

Poor Good Excellent

Quality of Treatment *

Poor Good Excellent

What else could we do to improve a patient’s experience in our office?

Name *

Telephone: *

E-Mail: *

1100 Richmond Ave. Unit B
Brandon, MB
R7A 1M6

Phone : 204-727-6453
Fax: 204-571-1560
Toll-Free: 1-866-727-0403

Monday – Friday 7:45 AM – 4:45 PM

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