Types of Appliances Questionnaire
Office Information
Your name
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Your email address
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Doctor or office name
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Office phone number
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Destination URL
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General Information
Do you offer a complimentary consultation?
What makes getting appliances at your office better than getting treated at another office?
Do you offer all the appliance treatments listed on your "Types of Appliances" page?
Yes, we offer all appliance treatments
No, we only offer select treatments (input treatments offered below)
Select treatments offered
Elastics (Rubber Bands)
In your own words, describe elastics.
How do elastics help improve a patient’s bite?
How frequently can a patient make adjustments to the color of their bands?
Forsus
In your own words, describe Forsus
Why should patients choose Forsus over headgear (who is the ideal candidate)?
What are the differences between headgear and Forsus?
How long does this treatment take overall?
How frequently would a patient need to come in for adjustments?
Headgear
In your own words, describe headgear.
Why should patients choose headgear over Forsus (who is the ideal candidate)?
What is the differences between headgear and Forsus?
How long overall does this treatment take?
How frequently would a patient need to come in for adjustments?
Herbst Appliance
In your own words, describe the Herbst appliance.
Why would patients need a Herbst appliance (who is the ideal candidate)?
How long overall does this treatment take?
How frequently would a patient need to come in for adjustments?
Palatal Expander
In your own words, describe a palatal expander.
Why would patients need a palatal expander (who is the ideal candidate)?
How long overall does this treatment take?
How frequently would a patient need to come in for adjustments?
Positioners
In your own words, describe positioners.
Why would patients need positioner treatment (who is the ideal candidate)?
How long overall does this treatment take?
How frequently would a patient need to come in for adjustments?
Retainers
In your own words, describe retainers.
Why would patients need a retainer (who is the ideal candidate)?
How long overall does this treatment take?
How frequently would a patient need to come in for adjustments?
Separators or Spacers
In your own words, describe separators or spacers.
Why would patients need separators or spacers (who is the ideal candidate)?
How long overall does this treatment take?
How frequently would a patient need to come in for adjustments?
Additional Information that could set you apart from your competition?
Do you have any patient testimonials (text or videos) or videos you have created for your practice or the treatments you offer? (Include a link to any YouTube videos you’ve created!)
Do you have before and after photos? If so, please attach them here
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