Oltjen Orthodontics

Doctor Login

Patient Login

Comment Form

Office Locations | Appointment Request | Comment Form | Refer a Friend

We enjoy having you as a patient and we are committed to making our relationship together as fulfilling as possible. In order to continue to serve happy patients, we would appreciate your suggestions and comments about our services.

Please fill out the following form and click the SUBMIT button to send us your comments. Because your comments are sent over the Internet, please do not include sensitive or personal information on this form.

Tell Us About Your Visit:

  1. Did our team greet your properly, ready and eager to assist you?

  2. Did you have to wait past your appointment time to be seated?

  3. Did our Team, and Dr. Oltjen, fully explain your dental situation, treatment outline, and financial options?

  4. Did your experience with us reflect the mission of our practice? "Ensure that every patient receives an exceptional experience with superior results!"

  5. Our practice values happy, satisfied patients and our success is based on our patients' recommendations. Would you refer your friends and family to us?

Contact Information:

  • May We Contact You?

  • Please Provide Your Contact Details:

Additional Comments:

  • Please comment on anyone you met during your visit, things we could do better, new services you would like to see, or other ways we can make you feel more comfortable in our practice.

Security and Submit:

  • For Security Purposes, Please Enter the Code Below:

Meet Our Doctor | About Our Practice | New Patients | About Orthodontics | Treatment Options | Contact Us | Home | Site Map

Web Site Powered by Sesame 24-7™