Post-Appointment Survey

We appreciate you choosing Southern Smiles Orthodontics, and we are committed to making sure that your time spent with us is as enjoyable as possible. In order to continue providing our patients with the best orthodontic experience, we encourage your comments and suggestions about the treatments and personal care you’ve received while visiting our office.


Please take a moment to provide us with your feedback. When you’re finished, click on the SUBMIT SURVEY button at the bottom of the page.

    Please describe your experience visiting our practice.*

    Please describe your experience working with Dr. Courtney and staff.*

    What was your favorite thing about being at our practice?*

    What areas could we improve upon to make your experience even more enjoyable?*

    How would you rate your overall experience?*

    Please provide any additional comments/suggestions.

    Would you like a member of our team to contact you to further discuss your experience?*

    *This form is not intended for submission of personal medical information.