Feedback - Roger J. Kaneshiro Orthodontics

Patient Feedback Form

We value our patient feedback because quality orthodontic care is important to us.

Scale of 1-10. 1 being poor and 10 being amazing.
Dr. Marketing
How was our pre-appointment communication?*

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Was your appointment scheduled at a convenient time for you?*

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Upon entering our practice, were you properly greeted by our team?*

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How did you find the cleanliness of our waiting area and practice?*

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Did our team explain your treatment, answer your questions, and listen to your concerns?*

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How likely are you to refer your friends and family to us?*

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How would you rate your overall quality of care with us?*

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Rating Calculation
Do you have any additional questions, comments, or concerns for us?
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