1 2<!DOCTYPE html> 3<!--[if lt IE 7]> 4<html lang="en" class="no-js lt-ie10 lt-ie9 lt-ie8 lt-ie7"> <![endif]--> 5<!--[if IE 7]> 6<html lang="en" class="no-js ie7 lt-ie10 lt-ie9 lt-ie8"> <![endif]--> 7<!--[if IE 8]> 8<html lang="en" class="no-js ie8 lt-ie10 lt-ie9"> <![endif]--> 9<!--[if IE 9]> 10<html lang="en" class="no-js ie9 lt-ie10"> <![endif]--> 11<!--[if gt IE 9]><!--> 12<html lang="en" class="no-js"> <!--<![endif]--> 13<head> 14 <meta charset="utf-8"> 15 <title>Post-Appointment Survey - Children's Dental Ark | New Braunfels TX</title> 16 <meta name="description" content="Providing quality pediatric dental care to children and teens in New Braunfels, TX. Call today to schedule your appointment at Children's Dental Ark with Dr. Cheryl Sellers!"> 17 <meta name="HandheldFriendly" content="True"> 18 <meta name="MobileOptimized" content="320"> 19 <meta name="viewport" content="width=device-width, user-scalable=0"> 20 <meta name="format-detection" content="telephone=no"/> 21 <!--[if IEMobile]> 22 <meta http-equiv="cleartype" content="on"> <![endif]--> 23 <!-- (111) 111-1111 --> 24 <!-- Standard desktop and mobile favicons --> 25 <link rel="icon" type="image/ico" href="/assets/images/favicon.png"> 26 <link rel="shortcut icon" href="/assets/images/favicon.png"> 27 28 <link rel="stylesheet" href="//srwd.sesamehub.com/assets/fonts/font-awesome-pro/css/fontawesome-all.min.css"> 29 30 <!-- CSS Stylings (Default Base Stylings and Site Specific) --> 31 <!--[if gt IE 8]><!--> 32 <link rel="stylesheet" href="/assets/css/material.css"> 33 <link rel="stylesheet" href="https://fonts.googleapis.com/icon?family=Material+Icons"> 34 <link rel="stylesheet" href="//srwd.sesamehub.com/assets/v5.0/global.min.css"> 35 <link rel="stylesheet" href="/assets/css/local.css?v=1791430543"> 36 <link rel="stylesheet" href="/assets/plugins/jquery.bxslider/jquery.bxslider.css" type="text/css"> 37 <!-- Testimonial Rotator --> 38 <link rel="stylesheet" href="/assets/plugins/testimonial-rotator/css/testimonial-rotator.css" type="text/css"> 39 <!--<![endif]--> 40 <link rel="stylesheet" type="text/css" href="https://fonts.googleapis.com/css?family=PT%20Sans%20Narrow:400,700%7CPT%20Sans:400,400italic,700,700italic"> <link id="local_fonts" rel="stylesheet" href="/assets/css/fonts.css?v=1791430543" type="text/css"> 41 <!--[if gte IE 8]> 42 <link rel="stylesheet" href="/assets/css/fonts.css" type="text/css" ; ?> 43 <![endif]--> 44 45 46 <!--[if lte IE 8]> 47 <link rel="stylesheet" href="//srwd.sesamehub.com/assets/v5.0/global-ie.min.css"> 48 <link rel="stylesheet" href="/assets/css/local-ie.css"> 49 <![endif]--> 50 51 <!-- Javascript Libraries --> 52
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59</head> 60 61<body class="post-appointment-survey sidebar-left footer-normal nav-top layout-standard layout-section-contact-us font-2"> 62 63<!-- Header --> 64<header id="hd"> 65 <!-- Logo --> 66 67 <a href="/" class="logo"><img src="/assets/images/logo.png" class="shift" alt="Children's Dental Ark Logo and Home Page" /><span class="logo-tagline"></span></a> 68 69 <div class="social-icons"> 70 <a href="https://www.facebook.com/Dentalarknb/" aria-label="Find us on facebook"> 71 <i class="fab fa-facebook-f linkHoverFade" aria-hidden="true"></i> 72 </a> </div> 73 74 <!-- Main Navigation --> 75 <nav id="main-nav" class="horizontal clearfix font-3"> 76 <div class="collapsible"> 77 <a href="javascript:void(0)" class="trigger">Tap for Menu <i class="fa fa-bars"></i></a> 78 <ul><li class="home first"><a href="/home" id="home" class="home"><span>Home</span></a></li><li class="about-us"><a href="/meet-our-doctors" id="about-us" class="about-us"><span>About</span> <span>Us</span></a><ul><li class="meet-our-doctors first"><a href="/meet-our-doctors" class="meet-our-doctors"><span>Meet</span> <span>Our</span> <span>Doctors</span></a></li><li class="meet-our-team"><a href="/meet-our-team" class="meet-our-team"><span>Meet</span> <span>Our</span> <span>Team</span></a></li><li class="office-tour last"><a href="/office-tour" class="office-tour"><span>Office</span> <span>Tour</span></a></li></ul></li><li class="new-patients"><a href="/office-visits" id="new-patients" class="new-patients"><span>New</span> <span>Patients</span></a><ul><li class="office-visits first"><a href="/office-visits" class="office-visits"><span>Office</span> <span>Visits</span></a></li><li class="testimonials"><a href="/testimonials" class="testimonials"><span>Testimonials</span></a></li><li class="financial-information"><a href="/financial-information" class="financial-information"><span>Financial</span> <span>Information</span></a></li><li class="patient-forms"><a href="/patient-forms" class="patient-forms"><span>Patient</span> <span>Forms</span></a></li><li class="pediatric-dental-faqs last"><a href="/pediatric-dental-faqs" class="pediatric-dental-faqs"><span>Pediatric</span> <span>Dental</span> <span>FAQs</span></a></li></ul></li><li class="pediatric-dentistry"><a href="/pediatric-dentistry" id="pediatric-dentistry" class="pediatric-dentistry"><span>Pediatric</span> <span>Dentistry</span></a><ul><li class="pediatric-dentistry first"><a href="/pediatric-dentistry" class="pediatric-dentistry"><span>Pediatric</span> <span>Dentistry</span></a></li><li class="why-choose-a-pediatric-dentist"><a href="/why-choose-a-pediatric-dentist" class="why-choose-a-pediatric-dentist"><span>Why</span> <span>Choose</span> <span>a</span> <span>Pediatric</span> <span>Dentist</span></a></li><li class="dental-care-for-your-baby"><a href="/dental-care-for-your-baby" class="dental-care-for-your-baby"><span>Dental</span> <span>Care</span> <span>For</span> <span>Your</span> <span>Baby</span></a></li><li class="the-importance-of-baby-teeth"><a href="/the-importance-of-baby-teeth" class="the-importance-of-baby-teeth"><span>The</span> <span>Importance</span> <span>of</span> <span>Baby</span> <span>Teeth</span></a></li><li class="gum-disease-in-children"><a href="/gum-disease-in-children" class="gum-disease-in-children"><span>Gum</span> <span>Disease</span> <span>in</span> <span>Children</span></a></li><li class="pediatric-dental-emergencies"><a href="/pediatric-dental-emergencies" class="pediatric-dental-emergencies"><span>Pediatric</span> <span>Dental</span> <span>Emergencies</span></a></li><li class="nutrition-and-oral-health"><a href="/nutrition-and-oral-health" class="nutrition-and-oral-health"><span>Nutrition</span> <span>and</span> <span>Oral</span> <span>Health</span></a></li><li class="baby-bottle-tooth-decay"><a href="/baby-bottle-tooth-decay" class="baby-bottle-tooth-decay"><span>Baby</span> <span>Bottle</span> <span>Tooth</span> <span>Decay</span></a></li><li class="special-needs-dentistry last"><a href="/special-needs-dentistry" class="special-needs-dentistry"><span>Special</span> <span>Needs</span> <span>Dentistry</span></a></li></ul></li><li class="preventive"><a href="/regular-exams-and-cleanings" id="preventive" class="preventive"><span>Preventive</span></a><ul><li class="regular-exams-and-cleanings first"><a href="/regular-exams-and-cleanings" class="regular-exams-and-cleanings"><span>
78Regular</span> <span>Exams</span> <span>and</span> <span>Cleanings</span></a></li><li class="healthy-smiles"><a href="/healthy-smiles" class="healthy-smiles"><span>Healthy</span> <span>Smiles</span></a></li><li class="dental-x-rays"><a href="/dental-x-rays" class="dental-x-rays"><span>Dental</span> <span>X-rays</span></a></li><li class="fluoride"><a href="/fluoride" class="fluoride"><span>Fluoride</span></a></li><li class="sealants"><a href="/sealants" class="sealants"><span>Sealants</span></a></li><li class="thumb-sucking"><a href="/thumb-sucking" class="thumb-sucking"><span>Thumb</span> <span>Sucking</span></a></li><li class="teeth-grinding"><a href="/teeth-grinding" class="teeth-grinding"><span>Teeth</span> <span>Grinding</span></a></li><li class="sports-dentistry last"><a href="/sports-dentistry" class="sports-dentistry"><span>Sports</span> <span>Dentistry</span></a></li></ul></li><li class="restorative-care"><a href="/fillings" id="restorative-care" class="restorative-care"><span>Restorative</span> <span>Care</span></a><ul><li class="fillings first"><a href="/fillings" class="fillings"><span>Fillings</span></a></li><li class="crowns"><a href="/crowns" class="crowns"><span>Crowns</span></a></li><li class="dental-abscess"><a href="/dental-abscess" class="dental-abscess"><span>Dental</span> <span>Abscess</span></a></li><li class="extractions"><a href="/extractions" class="extractions"><span>Extractions</span></a></li><li class="space-maintenance"><a href="/space-maintenance" class="space-maintenance"><span>Space</span> <span>Maintenance</span></a></li><li class="sedation-dentistry"><a href="/sedation-dentistry" class="sedation-dentistry"><span>Sedation</span> <span>Dentistry</span></a></li><li class="pediatric-hospital-dentistry"><a href="/pediatric-hospital-dentistry" class="pediatric-hospital-dentistry"><span>Pediatric</span> <span>Hospital</span> <span>Dentistry</span></a></li><li class="palatal-expander"><a href="/palatal-expander" class="palatal-expander"><span>Palatal</span> <span>Expander</span></a></li><li class="pulpotomy-pulpectomy"><a href="/pulpotomy-pulpectomy" class="pulpotomy-pulpectomy"><span>Pulpotomy/Pulpectomy</span></a></li><li class="home-care-instructions last"><a href="/home-care-instructions" class="home-care-instructions"><span>Home</span> <span>Care</span> <span>Instructions</span></a></li></ul></li><li class="contact-us active last"><a href="/new-braunfels-office-location" id="contact-us" class="contact-us"><span>Contact</span> <span>Us</span></a><ul><li class="new-braunfels-office-location first"><a href="/new-braunfels-office-location" class="new-braunfels-office-location"><span>New</span> <span>Braunfels</span> <span>Office</span> <span>Location</span></a></li><li class="appointment-request"><a href="/appointment-request" class="appointment-request"><span>Appointment</span> <span>Request</span></a></li><li class="post-appointment-survey active last"><a href="/post-appointment-survey" class="post-appointment-survey"><span>Post-Appointment</span> <span>Survey</span></a></li></ul></li></ul> </div> 79 </nav> 80 81 <div class="location-row"> 82 <div class="hd-location"><a href="/new-braunfels-office-location" class="hd-address">New Braunfels:</a> <a href="tel:8306251234" class="phone">(830) 625-1234</a> </div> <div class="hd-buttons"> 83 <ul><li class="book-now"><a href="/appointment-request"> 84 85 <i class="fa fa-calendar"></i> <span class="font-3">Book Now</span></a></li></ul> </div> 86 </div> 87</header> 88 89 90 <div class="interior-top"> 91 92 <!-- Sub Nav --> 93 <div id="subnav-outer" class="font-3"> 94 <div class="container row"> 95 <p><a href="/new-braunfels-office-location" class="new-braunfels-office-location">New Braunfels Office Location</a> | <a href="/appointment-request" class="appointment-request">Appointment Request</a> | <a href="/post-appointment-survey" class="post-appointment-survey active">Post-Appointment Survey</a></p> </div> 96 </div> 97 98 </div> 99 100 101<article id="content"> 102 103 <!-- Homepage Content --> 104 105 <div class="container row interior-content"> 106 107 <!-- Site Manager --> 108 109 <!-- Page Title --> 110 <header> 111 <h1>Post-Appointment Survey</h1> 112 </header> 113 114 <!-- Sidebar --> 115 <div id="sidebar"> 116 <div id="hide-stock"> 117 <img src="/assets/uploads/images/post-appointment-survey.jpg" alt="post appointment survey" /> <!-- call stock photos from php code above --> 118 </div> 119 120 <!-- Blog --> 121 122 </div> 123 124 <!-- Page Content --> 125 <div id="main-content"> 126 <p class="width2"> 127 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.</p> 128<p class="width2"> 129 Please take a moment to provide us with your feedback. When you're finished, click on the <strong>SUBMIT</strong> button at the bottom of the page.</p> 130<form action="/post-appointment-survey" class="width2 validate" method="post"> 131 <label for="Web_Address"><input id="Web_Address" name="sc_form[Web_Address]" type="hidden" /> </label> <input id="required_values" name="required_values" type="hidden" value="Contact_Patient" /> 132 <fieldset> 133 <legend>Please tell us about your appointment:</legend> 134 <p class="notice width1 box-round"> 135 <strong>Bold</strong> fields are required.</p> 136 <label class="first width2" for="My_Experience"><span>Please describe your experience visiting our practice.</span><textarea cols="30" id="My_Experience" name="sc_form[My_Experience]" rows="10" tabindex="1"></textarea></label> <label class="first width2" for="Experience_with_Team"> <span>Please describe your experience working with the doctor(s) and staff.</span><textarea cols="30" id="Experience_with_Team" name="sc_form[Experience_with_Team]" rows="10" tabindex="2"></textarea></label> <label class="first width2" for="Favorite_Thing_About_Practice"> <span>What was your favorite thing about being at our practice?</span><textarea cols="30" id="Favorite_Thing_About_Practice" name="sc_form[Favorite_Thing_About_Practice]" rows="10" tabindex="3"></textarea></label> <label class="first width2" for="How_Can_We_Improve"> <span>What areas could we improve upon to make your experience even more enjoyable?</span><textarea cols="30" id="How_Can_We_Improve" name="sc_form[How_Can_We_Improve]" rows="10" tabindex="4"></textarea></label> 137 <fieldset class="radio-group full"> 138 <p>
139 <span>How would you rate your overall experience?</span></p> 140 <div class="full" id="rating"> 141 <label class="first unitx1" for="Rating_Poor"><input id="Rating_Poor" name="sc_form[Rating]" tabindex="8" type="radio" value="Poor" /> <span>Poor</span></label> <label class="unitx1" for="Rating_Average"> <input id="Rating_Average" name="sc_form[Rating]" tabindex="7" type="radio" value="Average" /> <span>Average</span></label> <label class="unitx1" for="Rating_Good"> <input id="Rating_Good" name="sc_form[Rating]" tabindex="6" type="radio" value="Good" /> <span>Good</span></label> <label class="unitx1" for="Rating_Great"> <input id="Rating_Great" name="sc_form[Rating]" tabindex="5" type="radio" value="Great!" /> <span>Great!</span></label></div> 142 </fieldset> 143 <label class="first width2" for="Additional_Comments"><span>Please provide any additional comments/suggestions.</span><textarea cols="30" id="Additional_Comments" name="sc_form[Additional_Comments]" rows="10" tabindex="9"></textarea></label> 144 <hr /> 145 <div class="hr"> 146 </div> 147 </fieldset> 148 149 150 <fieldset> 151 <legend>Contact Information:</legend> 152 <p class="required loud first width2"> 153 <span>Would you like a member of our team to contact you to further discuss your experience?</span></p> 154 <select class="width1" id="Contact_Patient" name="sc_form[Contact_Patient]" required="required"><option value="">Select an option</option><option value="Yes">Yes</option><option value="No">No thank you; see you at my next appointment.</option></select> 155 156 157 <fieldset class="full hidden-option" id="survey_participant"> 158 159 160 <legend>Please provide your name and email address:</legend> 161 162 <label class="required first width1" for="Survey_Participant_Name"> <span>Your Name</span> 163 164 <input id="Survey_Participant_Name" minlength="2" name="sc_form[Survey_Participant_Name]" type="text" /> 165 <!--disabled="disabled" --> 166 167 <span class="quiet">First and Last</span></label> 168 169 <label class="required width1" for="Survey_Participant_Email"> <span>Your Email Address</span><br /> 170 171 <input id="Survey_Participant_Email" name="sc_form[Survey_Participant_Email]" type="email" /></label></fieldset> 172 <!--disabled="disabled" --> 173 174 <hr /> 175 <div class="hr"> </div> 176 177 </fieldset> 178 179 180 <fieldset> 181 <button class="button button-medium site-button-color box-round box-shadow">Submit Feedback</button></fieldset> 182</form> 183 </div> 184 185 </div> 186 187</article> 188 189<!-- Footer --> 190 191<div id="services-row"> 192 <div class="container row"> 193 <h2>Services</h2> 194 <ul class="span4" ><li> 195 196 <a href="/preventive-care" class="services-img" style="background-image: url(/assets/images/services/services-01.jpg);"> 197 <span class="services-text font-2">Preventive <span>Care</span></span> 198 </a> 199 200 </li><li> 201 202 <a href="/fillings" class="services-img" style="background-image: url(/assets/images/services/services-02.jpg);"> 203 <span class="services-text font-2">Restorative <span>Care</span></span> 204 </a> 205 206 </li><li> 207 208 <a href="/community-involvement" class="services-img" style="background-image: url(/assets/images/services/services-03.jpg);"> 209 <span class="services-text font-2">Community <span>Involvement</span></span> 210 </a> 211 212 </li></ul> </div> 213</div> 214 215<footer id="ft"> 216 <div class="container row"> 217 <h2>Our Location</h2> 218 219 <div class="ft-location-wrapper"> 220 <div class="ft-location"><a href="/new-braunfels-office-location" class="ft-map"><img src="/assets/images/maps/map-1.jpg" alt="New Braunfels Office " /><span class="ft-header font-3">New Braunfels Office </span></a><a href="/new-braunfels-office-location" class="ft-address">610 Landa St<br/>New Braunfels, TX 78130</a><a href="tel:8306251234" class="ft-phone">(830) 625-1234</a></div> </div> 221 222 </div> 223</footer> 224 225<div id="ft-contact"> 226 <div class="container row"> 227 <div class="contact-header"> 228 <i class="fa fa-envelope"></i> 229 <h2>Send Us A Message</h2> 230 </div> 231 <!-- contact form widget --> 232 <div id="ajax-mailer"> 233<form id="ajax-mailer-form" action="/contact-us-form/submit" class="validate" method="post"> 234<input id="required_values" name="required_values" type="hidden" value="Full_Name, Reply_To" /> 235<input id="ajax-mailer-name" data-minlength="5" name="sc_form[Full_Name]" placeholder="*Name" required="required" type="text" aria-label="Full Name" /> 236<input id="ajax-mailer-email" name="sc_form[Reply_To]" placeholder="*Email" type="email" aria-label="Email" required/> 237<textarea id="ajax-mailer-message" name="sc_form[Message]" placeholder="Message" aria-label="Message"> 238</textarea> 239<input type="submit" id="submit-ajax-mailer" value="Submit" /> 240</form> 241</div> </div> 242</div> 243 244<!-- Testimonial Rotator --> 245 246<div class="ft-logos"> 247 <a href = "/meet-our-doctors" ><img class="shift" src= "/assets/images/ft-logos/tda.png" alt = "tda" /></a ><a href = "/meet-our-doctors" ><img class="shift" src=//srwd.sesamehub.com/assets/images/ft-logos/american-academy-of-pediatric-dentistry.png alt = "American Academy Of Pediatric Dentistry" /></a><a href = "/meet-our-doctors" ><img class="shift" src=//srwd.sesamehub.com/assets/images/ft-logos/american-board-of-pediatric-dentistry.png alt = "American Board Of Pediatric Dentistry" /></a><a href = "/meet-our-doctors" ><img class="shift" src=//srwd.sesamehub.com/assets/images/ft-logos/american-dental-association.png alt = "American Dental Association" /></a></div> 248 249<!-- Design Credit --> 250<div class="ft-design-credit aligncenter"> 251 <div class="container row"> 252 <p class="text-nav"><a href="/home" class="home">Home</a><a href="/meet-our-doctors" class="about-us">About Us</a><a href="/office-visits" class="new-patients">New Patients</a><a href="/pediatric-dentistry" class="pediatric-dentistry">
252Pediatric Dentistry</a><a href="/regular-exams-and-cleanings" class="preventive">Preventive</a><a href="/fillings" class="restorative-care">Restorative Care</a><a href="/new-braunfels-office-location" class="contact-us active">Contact Us</a><a href="/sitemap">Site Map</a></p> <div class="design-credit-right"> 253 <a class="sesame-link" href="http://www.sesamecommunications.com/web-design"> 254 <i class="fa icon-sesame-arrow"></i> Website Powered by Sesame 24-7™ 255 </a><!-- | <a href="/sitemap">Site Map</a> --> 256 <a class="back-to-top" href="#hd" aria-label="back to top"><i class="fa icon-top" 257 aria-hidden="true"></i></a> 258 </div> 259 </div> 260</div> 261 262<div class="mdl-button--fab_flinger-container" id="fab_ctn"> 263 <a class="mdl-button mdl-js-button mdl-button--fab mdl-js-ripple-effect mdl-button--colored" id="fab_btn"><span class="button-text">Contact Us!</span></a> 264 <div class="mdl-button--fab_flinger-options"> 265 <div class="vsnotnumber"> 266 <a class="mdl-button mdl-button-text mdl-js-button mdl-button--fab mdl-js-ripple-effect child" href="sms:830-625-1234"> 267 <i class="material-icons">textsms</i> 268 </a> 269 </div> 270 <a class="mdl-button mdl-button-call mdl-js-button mdl-button--fab mdl-js-ripple-effect child" href="tel:830-625-1234"> 271 <i class="material-icons">call</i> 272 </a> 273 <a class="mdl-button mdl-button-email mdl-js-button mdl-button--fab mdl-js-ripple-effect child" href="mailto:[email protected]"> 274 <i class="material-icons">email</i> 275 </a> 276 </div> 277</div> 278 279<!-- First Call etc--> 280 281<!-- Additional scripts (Mobile Helpers, Console Detector, etc) -->
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284 285<!-- Testimonial Rotator -->
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