Survey | South Tampa FL | Farina Orthodontics

Patient SUrvey

Patient Name
Email Address

Overall, how would you rate your most recent office visit?
Great Good Fair Poor

Upon arrival, were you greeted promptly and pleasantly?
Yes No

With regards to your appointment: Were you seated on time?
Yes No

If not, were you kept apprised of any changes to the appointment time?
Yes No

If yes to the above, how long was your appointment delayed?


How would you rate your understanding of your oral health and treatment options?
Great Good Poor

Did the explanation of your payment and insurance options meet your needs?
Yes No

Do you feel that Doctor Farina and his team members devoted an appropriate amount of time to answering your treatment questions?
Yes No

How likely are you to recommend us to your friends and family?
Strongly Agree Agree Disagree Strongly Disagree

Which team member recommended that you complete this survey?
Jana Jen Cathy Gail

Please provide us with any ways in which we could improve our services:


May we use your feedback within the contexts of our web pages or promotional/training material?
Yes No

Verification Code (case sensitive):

Orthodontist Mark Farina — Farina Orthodontics

South Tampa
4726 North Habana Avenue
Suite 102
Tampa, FL 33614
T 813-877-5511
F 813-877-5630

New Tampa
15303 Amberly Drive
Suite E
Tampa, FL 33647
T 813-972-2929
F 813-977-1471

Call Us: 813 972 2929