Feedback

YOUR NAME (required)

PHONE (required)

EMAIL (required)

DATE OF BIRTH (required)

DATE OF LAST VISIT (required)

DENTISTDr Jessica ManuelaDr Imran KhanDr Jay LungDr Phoebe ProwseDr Adib Kashani

Please rate your experience from 1 to 5, 5 being superb:

DID THE DENTIST AND STAFF TREAT YOU WITH DIGNITY AND RESPECT?12345

WAS THE TREATMENT COMFORTABLE?12345

WAS THE CLINIC CLEAN?12345

WERE YOU HAPPY WITH YOUR TREATMENT OPTIONS?12345

WAS THE DENTIST RUNNING ON TIME?12345

WILL YOU BE HAPPY TO RE-BOOK WITH OUR TEAM IN THE FUTURE? 12345

WOULD YOU RECOMMEND DENTAL SOUTH TO A FRIEND?YesNo

I acknowledge that this feedback is confidential and will be used to improve the quality of care at Dental South. I am a patient of Dental South or Dental South Bayview. I understand that providing untrue or misleading information will be further investigated by the appropriate authorities.

ADDITIONAL FEEDBACK: