Dental Clinic
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Your dental visit — quick feedback

Tell us about today’s dental experience. Not for emergencies or clinical disputes.

About 2 minutes. Your answers help us improve every smile we care for.

Questions marked * are required.

Who is filling this form? *

What service did you receive today? *

Overall, how was today’s visit? *

1 — Very poor5 — Excellent

How would you rate reception / registration / payment today? *

1 — Very poor5 — Excellent

Was the waiting time acceptable? *

Were staff polite and respectful? *

1 — Very poor5 — Excellent

How clean and comfortable was the facility? *

1 — Very poor5 — Excellent

How well was pain managed during treatment? *

1 — Very poor5 — Excellent

Did the dentist explain the treatment clearly? *

Were fees / costs explained clearly before treatment? *

How likely are you to recommend us to others? *

0 — Not at all likely10 — Extremely likely

What is one thing we could improve? (Optional)

What did we do well today? (Optional)

May we contact you about this feedback?

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