I.   GENERAL OFFICE ATMOSPHERE

The office location is:

very easy to find not too difficult to find difficult to find

The overall atmosphere and feeling in the office is:

warm and inviting pleasant uneasy and intimidating disorganized and chaotic

When I phone the office I am treated:

with prompt, courteous attention pleasantly indifferently abruptly

The staff member answering the phone:

answers with a smile, is well-informed, and professional is informed but indifferent is rude and not helpful

When entering the office I am treated by the receptionists:

like being in the home of an old friend pleasantly & courteously indifferently coldly

The overall office cleanliness is:

immaculate clean usually clean rarely clean

II.   COMMUNICATIONS AND SCHEDULING

All Communications - including the New Patient Examination, Treatment Conference, starting treatment verbal instructions, and written correspondence related to treatment were:

thoroughly explained and to my understanding explained adequately vague and unclear I did not understand and had many questions unanswered

I find the scheduling system including attention to individual needs and availability of appointments to be:

convenient usually convenient sometimes inconvenient inconvenient

Generally, scheduled appointments are started and completed:

with precision timing approximately on time with high regard for the patient's time always late with no regard to the patient's time

III.   FINANCIAL

Financial Arrangements and Payment plans were:

arranged to meet my needs (special payment terms were available) reasonable rigid with no flexibility

Information and help with insurance coverage was provided:

immediately and accurately promptly within a reasonable period of time with delays poorly and inaccurately

IV.  OVERALL CARE

Dr. Berkowitz and staff treated me or my child:

as a friend with the utmost care and concern in a friendly, professional manner indifferently coldly

If there was ever a treatment problem, Dr. Berkowitz and staff took care of it:

immediately and at the patients convenience within a reasonable amount of time with some delay not at all have never had a treatment problem

Dr. Berkowitz and staff, when needed to provide information regarding treatment, are:

always accessible and willing to provide information immediatly usually accessible sometimes available unavailable

V.   TREATMENT QUALITY

My principle reason for selecting this office was:

referral by family dentist referral from another family member treated in the office referral from another patient treated in the office yellow pages location word of mouth

Based on your or your families experience with our office, would you recommend our office to your friends and relatives who may need orthodontic treatment:

we have on many occasions with total confidence without hesitation with some reservations not at all

In my opinion, the quality of orthodontic work performed is:

excellent good satisfactory unsatisfactory

VI.  SPECIAL INDIVIDUAL COMMENTS

Do you or your child feel good about being treated in our office?

Do you find our staff as courteous and concerned as you would like?

In your opinion, what are the strongest and/or weakest aspects of our practice?

Please tell us how we can better serve you or improve our service.

List your favorite magazines, radio stations and type of music, so we can make your visits more enjoyable and comfortable.

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