Doctor Name
*
Patient Name
*
Case Number (e.g. CN123456)
*
Rate the Grammetry / PhotoG case overall
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Rate ROE's turnaround time
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Rate how the lab followed design instructions and photographs
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Rate how the prothesis seated
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Rate the bite
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Rate the midline
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Rate the prothesis thickness
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Rate the lab communication, if requested
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Please provide all relevant information
Would you like to speak to a senior member of the ROE team about this case
Yes
No
Phone Number
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