We welcome any feedback or suggestions you might have, please fill out the form below and a member of our team will be in touch. "*" indicates required fields Name* Email* Subject* What date did you visit us on?* DD slash MM slash YYYY What Clinic Did You Visit?*- Please Select -LimerickShannonClaremorrisRoscommonWhat type of appointment was it?- Please Select -GeneralEmergencyCosmeticOrthodonticHow would you rate your dentist?*-Rate the Staff -ExcellentVery GoodGoodFairPoorWould you recommend this dentist to a friend?* Yes No Did you find accurate time was given for your appointment?* Yes No Did you find the staff helpful*- Rate the Staff -ExcellentVery GoodGoodFairPoorDid you feel the surroundings and equipment were efficient?* Yes No Were the dentist and staff attentive to your requests & needs?* Yes No Will you visit Alexandra Dental in future?* Yes No Additional CommentsPreferred Contact Method* Phone Email Preferred Contact Time*- Please Select A Time -MorningAfternoonEvening*Please note that some of this information may be used for other marketing purposes
