Your dental visit — quick feedback

Visit code from reception *

Ask reception for a one-time code after payment. Without this code you cannot submit feedback.

Who is filling this form? *

What service did you receive today? *

Overall, how was today’s visit? *

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

Was the waiting time acceptable? *

Were staff polite and respectful? *

How clean and comfortable was the facility? *

How well was pain managed during treatment? *

Did the dentist explain the treatment clearly? *

Were fees / costs explained clearly before treatment? *

How likely are you to recommend us to others? *

What is one thing we could improve? (Optional)

What did we do well today? (Optional)

May we contact you about this feedback?