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About Us
Our Clinic
Our Team
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Book Appointment
Blog
Leave a Review
Contacts
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+254 798 040 111
Patient Feedback Form
Your Feedback Helps Us Improve
First Name
Last Name
Date of Visit
Dentist Name
Was your appointment scheduled promptly and conveniently?
Yes
No
Did you receive a reminder notification before your appointment?
Yes
No
Rate your overall satisfaction with the appointment scheduling process.
(1 is Very Dissatisfied, 5 is Very Satisfied).
1
2
3
4
5
How would you rate the friendliness and professionalism of the front desk staff?
(1 is Poor, 5 is Excellent)
1
2
3
4
5
Were you seen by your dentist/provider in a timely manner?
Yes
No
How would you rate the communication and explanation of your dental treatment plan by your dentist/provider?
(1 is Poor, 5 is Excellent)
1
2
3
4
5
Were you satisfied with the overall ambiance and atmosphere of the clinic?
Yes
No
Based on your visit today, would you recommend our dental clinic to friends or family?
Yes
No
Please share any additional comments, suggestions or feedback about your experience at our dental clinic.
Send Feedback
First Name
Last Name
Date of Visit
Dentist Name
Was your appointment scheduled promptly and conveniently?
Yes
No
Did you receive a reminder notification before your appointment?
Yes
No
Rate your overall satisfaction with the appointment scheduling process.
(1 is Very Dissatisfied, 5 is Very Satisfied).
1
2
3
4
5
How would you rate the friendliness and professionalism of the front desk staff?
(1 is Poor, 5 is Excellent)
1
2
3
4
5
Were you seen by your dentist/provider in a timely manner?
Yes
No
How would you rate the communication and explanation of your dental treatment plan by your dentist/provider?
(1 is Poor, 5 is Excellent)
1
2
3
4
5
Were you satisfied with the overall ambiance and atmosphere of the clinic?
Yes
No
Based on your visit today, would you recommend our dental clinic to friends or family?
Yes
No
Please share any additional comments, suggestions or feedback about your experience at our dental clinic.
Send Feedback
