Patient Request Form

Dear Patient,

At Casas Clinics, your health and satisfaction are our top priorities. We proudly would like to utter that we are an international company which hosts thousands of patients a year. As Casas, we care , we listen , we solve the problems.

Thus, After you have had your treatment, we would like to gather feedback from you. Please carefully answer the following questions to evaluate your experience. Your feedback will help us improve the quality of our services and provide a better experience for our future patients.

Full Name

Phone Number

Nationality

Deposit Amount

Date Treatment

Do you have any problem with your teeth? If you do, please write below.

Have you had any unusual failure, pain, falling of teeth, coming off of the dentures, infection etc. ?

When did your problem begin? Is it still going on?

How did you hear about Casas Clinics' services?

How would you evaluate your experience with the transfer process? How helpful was our transfer service to you?

How was the attitude and hospitality of our clinic staff towards you?

How would you evaluate your experience with the treatment purchasing process

Are you satisfied with the information and communication?

Did you receive sufficient information about the treatment process? Did you feel any areas were lacking?

How was the attitude of our healthcare team towards you during the treatment process? Were you provided with a suitable treatment plan?

What are your thoughts on the effectiveness of the treatment? Are you satisfied with the results?

Are you satisfied with our transfer and accommodation services during the treatment process? If no Why?

How was the cleanliness , order and hygiene of the clinic environment?

Are you satisfied with our post-treatment communication and follow-up services? Did you receive the necessary support?

Would you recommend Casas Clinics to others?

Is there any area where we can improve during the treatment process? If yes, please explain.

Could you provide a brief statement expressing your satisfaction after the treatment?

We thank you for taking the time to complete this form. By evaluating the feedback we receive from you, we aim to improve the quality of our services. We will continue our efforts to enhance your health tourism experience.

Best regards,

Casas Clinics Patient Satisfaction Team

We Are Here For You

The Personal Data Protection