Post-Appointment Survey

Thank you for visiting Girgis & Ito Orthodontics. We are always working hard to give you the optimal care in a friendly and professional setting. Your feedback is very important to us. It helps us understand what we are doing well and how we can make our next visit even better.

Please take a few minutes to fill out our post-appointment survey. Your thoughts will help us improve the way we care for you and your smile.

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This field is for validation purposes and should be left unchanged.

Please describe your experience visiting our practice.(Required)

Please describe your experience working with the dentist(s) and staff.(Required)

What was your favorite thing about being at our practice?(Required)

What areas could we improve upon to make your experience even more enjoyable?(Required)

How would you rate your overall experience?(Required)

Choose one:

Poor

Average

Good

Great!

Additional Comments or Suggestions

If there’s anything else you’d like to share, please write it here. Every comment helps us grow.

Would you like a member of our team to contact you to talk more about your experience?(Required)

Please provide your name and email address so we can follow up if needed:(Required)

Your First and Last Name

Your Email Address(Required)

Your Email Address

Once you’ve filled everything out, just click the SUBMIT button at the bottom of the page.

At Girgis & Ito Orthodontics, we care about more than just straight teeth—we care about you. Thank you for helping us make your care even better.

We’re so happy you’re part of our orthodontic family.