Untitled Document

Patient Name:

Patient Manager:

Please select the choice that best corresponds to your experience here at Dr. Lach's office.

(1 = never, 2 = sometimes, 3 = frequently, 4 = almost always, 5 = always)

The Lach Orthodontics Team shows a true concern for their patients, not just for their teeth, but for the patient as a person.

1	2	3	4	5

The Lach Orthodontics Team is extremely knowledgeable in the field of orthodontics. They appear to be well-trained and experienced in orthodontic patient treatment.

1	2	3	4	5

The Lach Orthodontics office appears to be on the cutting edge of technological advancements, using the most up-to-date, well-maintained equipment.

1	2	3	4	5

Dr. Lach's office is a great place to visit—clean, impeccable facilities, fun theme, and great atmosphere.

1	2	3	4	5

I was always greeted by name with a smile upon entering the office. My concerns were treated seriously, and all my questions were answered.

1	2	3	4	5

Each appointment occurred in a timely manner. Waiting time was acceptable.

1	2	3	4	5

Each step of treatment was thoroughly explained to me; and I was consistently updated on treatment progress.

1	2	3	4	5

I know what to do if a problem arises with the braces or appliances that you currently have?

1	2	3	4	5

I would gladly recommend Dr. Lach to my family and friends.

1	2	3	4	5

Please comment on any areas that you feel we could improve:

Please tell us what you like best about our office and the Lach Orthodontics team:

Verification Code:

Enter to Win an iPod Shuffle

Share your orthodontic experience with your friends by referring 5 of them and you will be entered into our monthly drawing for a FREE iPod Shuffle!
Limit one per family.