Patient Feedback Form
Our team at Heritage Village Dental Clinic cares to provide you with the best service and dental experience. We are committed to consistent excellence and improvement. Please tell us how we did! 
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Optional: What is your name?
Optional: What day was your appointment?
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Who had a positive impact on you? Select all that apply. *
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What were the positive aspects of your stay?
How could we do better next time?
Any other comments?
Thank You So Much!
Your time and input means a lot to us! Have a wonderful rest of your day!
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