Name
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Patient Name
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First Name
Last Name
E-mail
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Prior to starting the program, rate crowns coming from ROE
Please Select
1 - Very satisfied
2 - Somewhat satisfied
3 - Neutral
4 - Somewhat dissatisfied
5 - Very dissatisfied
Did you feel that ROE listened to your feedback and made proper design adjustments as the program progressed?
Please Select
1 - Listened and made all the changes
2 - Listened and made the majority of changes
3 - Listened but made very few changes
4 - Listened but didn't make any changes
5 - Didn't listen
Did the time to seat a crown improve compared to before the program?
Please Select
1 - Much improved than before the program
2 - Somewhat improved than before the program
3 - Neutral
4 - Slightly worse than before the program
5 - Very much worse than before the program
What is the likelihood you will continue to send your crown and bridge work to ROE now that the Calibrate program is complete?
Please Select
1 - Certain to send more crowns
2 - Likely to send more crowns
3 - Neutral
4 - Somewhat unlikely to send any crowns
5 - Very unlikely to send any crowns
Additional comments, feedback, anything we can do better to improve the program and your overall experience with ROE?
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