Survey

Your name

Your e-mail

How often do you visit the dentist?

Once a few year

Once a year

Once a month

Only when I have a toothache

How do you assess the quality of services in our clinic?

Do you have a dentist who you visit regularly?

Yes

No

How did you hear about our clinic?

Advised friends

Advised family members

Advised by another dentist

From advertising

When did you first visit our clinic?

Would you recommend our clinic to your friends?

Yes

No

Give us your recommendations