This feedback template includes 10 fields. Gather patient and parent feedback on orthodontic treatment, staff, office experience, and results. Free to customize and use on ZenBuild.
Patient or Guardian Name (text, optional)
Email Address (email, optional)
Treatment Type (dropdown selection, required) — options: Traditional Braces, Clear Aligners, Retainers, Consultation Only
Treatment Results (rating, required)
Doctor Communication (rating, required)
Staff Friendliness (rating, required)
Office Comfort (rating, required)
Value for Cost (rating, required)
Would You Recommend This Practice? (multiple choice, required) — options: Strongly Yes, Yes, Maybe, No
