Full Name

Phone

Email *

1. How was your overall experience with our dental clinic?

Excellent

Good

Average

Poor

Staff friendliness and professionalism:

Excellent

Good

Average

Poor

Cleanliness of the clinic:

Excellent

Good

Average

Poor

Waiting time before your appointment:

Very Short

Acceptable

Long

Very Long

Quality of dental treatment received:

Excellent

Good

Average

Poor

3. Was the dentist able to clearly explain your diagnosis and treatment options?

Yes

Somewhat

No

4. Did you feel comfortable and cared for during your visit?

Yes

Somewhat

No

5. Would you recommend our clinic to your friends and family?

Definitely

Maybe

No

6. Do you have any suggestions or comments to help us improve?