Home » Appliance Satisfaction Survey Appliance Satisfaction Survey At Excel Orthodontics, we believe ongoing communication is the key to a successful laboratory-practice partnership. That’s why we always want to hear from you! Dr. Name / Clinic * Patient Name or Case # * Phone * Email Address * Model Type Model Type Stone Model Digital Scan Overall band/crown fit? Overall band/crown fit? Unacceptable Unsastificatory Satisfactory Excellent Outstanding Overall Acrylic Trim/Thickness/Color or design? Overall Acrylic Trim/Thickness/Color or design? Unacceptable Unsastificatory Satisfactory Excellent Outstanding Overall Wire and/or Clasping? Overall Wire and/or Clasping? Unacceptable Unsastificatory Satisfactory Excellent Outstanding Overall Appliance Satisfaction? Overall Appliance Satisfaction? Unacceptable Unsastificatory Satisfactory Excellent Outstanding Prescription and/or Preferences followed? Prescription and/or Preferences followed? Yes No Would you like a customer service representative to call and set up custom appliance preferences? Would you like a customer service representative to call and set up custom appliance preferences? Yes No Additional comments/feedback: 11 + 7 = Submit