Feedback and Complaints Form

: 020 8886 0325
Mon-Fri: 9.00am-5.30pm

12 Fox Lane
Palmers Green
London N13 4AH

    Patient's Name*

    Patient's Email*

    Your visit was on: (YYYY-MM-DD)

    Contact Phone Number*

    Overall rating for this dentist:

    How satisfied were you with the time you had to wait for an appointment?

    Were you treated with dignity and respect by staff at the practice?

    How satisfied were you that the dental practice involved you in decisions about your care?

    How satisfied were you with the information given by the practice on the cost of your treatment?

    How satisfied were you with the outcome of your treatment?

    Can you tell us briefly what you liked or disliked about your visit?

    What could have been improved upon?

    Please summarise your overall experience in a single sentence.

    Please enter the Validation below: