Patient Feedback Form

What we do

As we strive to consistently improve our services at Absolute Dental in Prestwich, we seek your sincere feedback. Please help us by taking a few minutes to answer the following questions:

How did you hear about us?
AdFlyerDirect MailMagazineFriendFamilyOther

Date of last visit:

I had a prior
Appointmentwalk In

Did you find our working hours convenient for you?
Very ConvenientConvenientSomewhat ConvenientNot Convenient

Did you find our parking convenient?
Very ConvenientConvenientSomewhat ConvenientNot Convenient

Upon entering our clinic, were you properly greeted, and acknowledged by our staff?
ExcellentVery GoodGoodAveragePoor

Did the waiting area look clean and orderly?
ExcellentVery GoodGoodAveragePoor

How long did you wait before being seen by the dentist?
0 Min5 Mins15 Mins30 MinsMore

Was the receptionist helpful, polite and pleasant?
ExcellentVery GoodGoodAveragePoor

Was the dental assistant(s) friendly, supportive and confident?
ExcellentVery GoodGoodAveragePoor

Was the Dentist who attended you confident and focused?
ExcellentVery GoodGoodAveragePoor

Did the Dentist explain your treatment, answer your questions, and listen to your concerns?
ExcellentVery GoodGoodAveragePoor

Did the clinic chamber seem clean and hygienic?
ExcellentVery GoodGoodAveragePoor

The level of dental treatment I received was:
ExcellentVery GoodGoodAveragePoor

How would you rate the overall quality of service you received at Citylife Dental?
ExcellentVery GoodGoodAveragePoor

Would you recommend us to your family, friends and co-workers?
YesMaybeNO

Additional Comments or Suggestions:

If this is a complaint, do you wish to be contacted for follow-up?
YesNO

The following information is optional, but is required if you wish to be contacted:

Name

Email

Phone

Contact us for a consultation

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