TOOTHFAIRY CLIENT FEEDBACK FORM

Feedback form

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* 1. How would you rate the customer service received at your appointment? (10 completely satisfied) (1 unsatisfied)

1

2

3

4

5

6

7

8

9

10

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* 2. How would you rate your results received at your appointment?

Better than expected

Exactly as expected

Not as good as expected but still satisfied

I was unsatisfied with my results

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* 3. In your own words how would you describe how you felt during the appointment and anything that could improve?

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* 4. Would you recommend LaserX to friends and family who were interested in Teeth Whitening?

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* 5. How have you felt since your appointment?

My overall confidence has improved

I feel more comfortable smiling in photos/ having conversations/ smiling

I feel the same

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* 6. Lastly, Did you feel your appointment was good value for money?

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* 7. Did you have any of the following side effects?

Tooth Sensitivity

Dry Mouth

Gum Irritation

No side effects