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1. How old are you?
 
less than 10 years old
 
10-18
 
19-27
 
above
 
 
 
2. How often do you go to dentist for checkups?
 
every 6 months
 
once a year
 
once every 2 years
 
only when i have a problems
 
 
 
3. what was the purpose of your visit to the dental clinic ?
 
crowns
 
bridges
 
fillings
 
cleaning
 
 
 
4. How much time you wait in clinic ?
 
less than one hour
 
1 hour
 
2 hour
 
above
 
 
 
5. what is your opinion on the services provide in this clinic?
   
 
 
6. Have any solution to solve the problems in this clinic, if exist?