Patient survey

Your opinion is important to us!

Your gender?
Male Female

Your age?

Where did you get information about our medical facility?

Recommended by (family, friends, colleagues)
Information on the internet
Information in newspapers

Recommended by a doctor
I am a regular visitor to Valis Dentistry
Other

Why did you choose Valis Dentistry?

The specific dentist
Convenient location

Affordable prices
Other

Name of dentist

Your opinion is very important to us!

Please justify your answer

Did your health professional answer your questions clearly and comprehensively?
Yes No Partially

Your feedback, suggestions or criticisms

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