Survey

Your name

Your email

How often do you visit the dentist?

Once in several years

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?

Advice from friends

Advice from family members

Advice from another dentist

Advertising

When did you first visit our clinic?

Would you recommend our clinic to your friends?

Yes

No

Additional feedback and comments