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Post-Appointment Survey

We appreciate you choosing our practice, and we are committed to making sure that your time spent with us is as comfortable and fulfilling as possible. In order to continue providing the kind of care that keeps our patients smiling, we encourage your comments and suggestions about the treatments and personal care you've received while visiting our practice.

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

Please tell us about your appointment:

Bold fields are required.

How would you rate your overall experience?


 
Contact Information:

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

Please provide your name and email address:

 
Wilkinson Orthodontics rewards

Get Rewarded

Successful orthodontics is a team effort and YOU are our key player! We've created our Ortho Bucks and Kids Club Rewards Programs to recognize your accomplishments and congratulate your winning achievements. These are incentive programs based on your compliance.
You set the bar… every visit is an opportunity to earn ortho bucks for cool prizes.

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Changing Smiles

Changing Lives

Nominate a child or adult to get free braces

We choose two exceptional individuals to receive complimentary, full orthodontic treatment. Our winners are chosen based upon letters of recommendation by their friends and loved ones describing their need, character, and how they have helped others in need, plus a personal interview with our team members.

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