Feedback form

General Information

How did you find out about the clinic?

How would you rate the access to the clinic?

Scheduling Your Appointment

How did you schedule your appointment?

Was your enquiry handled promptly?

Was the person who scheduled your appointment courteous and helpful?

Day of Your Appointment

How would you rate the courtesy of the staff at the reception desk?

How long did you wait in the reception area beyond your scheduled appointment time?

Your Oral Health Clinician

How would you characterise the demeanor of your clinician?

Please rate the clarity of the clinician's explanation of your condition and treatment options?

Were your questions answered to your satisfaction?

The Facility

How would you rate the facility?

Would you recommend this facility and its staff to your family and friends?

How would you rate our concern for your privacy?

Additional Comments

Please share any additional comments or suggestions

Contact Information

Full Name

Telephone

Verification