(Pramod Dental & Oro-Maxillofacial Clinic)
Center for Advanced Dentistry, Dentofacial Trauma, Deformities and Dental Implants
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Feedback Form
Dear friend,

By filling and sending us the feedback form given below, you are contributing to improving our services to you.

Hence, please take a few seconds of your valuable time to fill in the form and send us the same.

Please note that only registered patients of Pramod clinics (Valanjambalam & Narakkal) and of the Dental & Faciomaxillary Dept., Saraf Hospital, need fill this form (you would have been allotted an OP no: which is noted in the OP card provided to you at the time of registration).

Best wishes,
Dr. Prasanth Pillai

1)  How did you report to this clinic for treatment, the first time ? (kindly tick appropriately)

Seeing the Clinic board
Referred by another patient / person who has visited this clinic
Seeing the clinic advertisement - eg. Yellow Pages, Hello Cochin etc.
Via Internet
Referred by a doctor           Name  Dr     Specialty
Other means (please specify)


2) Did you understand clearly about the dental and related problems you have/had and about the treatment procedures performed on you ?     Yes      No

3)  Did you experience problems while undergoing treatment?       Yes      No

4)  Kindly fill these columns appropriately:

Please select appropriately Remarks if any
Service Poor Satisfactory Good Excellent
Behavior and attitude of staff
Behavior and attitude of doctors
Promptness in service
Treatment provided
General clinic arrangements & set-up
Cleanliness of the clinic and surroundings

5)  Are you aware of the various treatment facilities offered by this clinic ?            Yes      No

6) What do you feel about the professional fees being  collected towards  treatment and allied services in our clinic ?            

      Low      Moderate      Excessive

7) Your suggestions on our website.

We welcome your suggestions on how we can improve our services.

Your Name:
Pramod Clinic / Saraf Hospital - OP No:


Thank you for spending your valuable time to complete this
We look forward to serving you even better.


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