Emergency Orthodontics Questionnaire
Office Information
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Doctor or office name
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Office phone number
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General Information
In your own words, what is emergency orthodontic care?
What types of treatments does emergency orthodontics include?
If patients experience an orthodontic emergency, what should they do?
Describe in your own words treatment for a headgear emergency.
Describe in your own words treatment for a loose appliance emergency.
Describe in your own words treatment for a loose bracket emergency.
Describe in your own words treatment for a loose wire emergency.
Describe in your own words treatment for a poking wire emergency.
Describe in your own words treatment for general soreness.
Describe in your own words treatment for patients who experience facial trauma.
Your Experience
What technologies/techniques do you use in your practice that aid in better results/faster treatment and recovery time/ provide patients with a more comfortable experience?
What accreditations/certifications/awards specifically for emergency orthodontics have you received?
Why should someone receive emergency orthodontic treatment at your practice? (Don’t be shy, this is where you should toot your own horn!)
Additional Information that could set you apart from your competition?
Do you have any before and after photos of emergency cases? (resembling headshots, preferably, rather than close-ups of teeth with lip retractors) Do you have any patient testimonials (text or videos) or videos of you discussing emergency orthodontics? (Include a link to any YouTube videos you’ve created!)
Do you have before and after photos? If so, please attach them here
Upload Files
Include in separate attachments on e-mail or send a Dropbox link if you are experiencing any issues!
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