Patient Feedback Form

Patient Feedback Form

Please spare us a few minutes to share your experience with us. Your feedback is of utmost value to us. We could use this information to improvise on our standard of care to our patients.

Please note this questionnaire will be kept confidential.

Male
Female
Please note this questionnaire will be kept confidential.
1. Upon entering our clinic, were you properly greeted & acknowledged by our staff?
Yes
No
2. Was the Receptionist helpful, polite & pleasant?
Yes
No
3. How long did you wait before being seen by the dentist?
2mins
5mins
15mins
30mins
More
4. Are you satisfied with the facility, ambience & comfort provided at our clinic?
Yes
No
5. Was the hygiene & cleanliness satisfactory?
Yes
No
6. Was the dentist who attended you confident and focused?
Yes
No
7. Did the dentist explained your treatment plan, answered your questions & listened to your concerns?
Yes
No
8. Time taken for billing?
Very Quick
Quick
Reasonably Quick
Long
Very Long
9. Do our working days and clinic timings suit you?
Yes
No
10. Are you satisfied with the payment options & overall cost of the treatment?
Yes
No
11. Would you recommend us to your family, friends &co-workers?
Yes
No
12. Additional comments or suggestion for further improvement :
Belgaum Kolhapur
Thank you for your valuable time & for your insight. It helps us to serve you better!!