Tel: 0117 9238 400 Fax: 0117 9467 007 Email: info@rootfillings.com

Sorry

Sorry, you did not complete the form correctly, please ensure you fill in every box before clicking submit, alternatively if you wish to print out the feedback form and bring it with you to the practice, please click here:-

    • Dull ache:
    • Throbbing pain:
    • Tender over the gum:
    • Tender to biting:
    • Sharp, stabbing pain:
    • Tender only where the injection was given:
    • Immediately after the anesthesia wore off:
    • Later that same day:
    • Next day:
    • 2 days later:
    • After 2 days:
    • Same
    • Increasing daily
    • Decreasing daily
    • I am not sure
    • Not present now
    • Very minor now
    • Episodic
    • None
    • ASA/Aspirin
    • Tylenol
    • Codeine or other narcotic (Vicodin)
    • Non-steroid anti-inflammatory
    • (Drug name: )
    • How many pills did you take?
    • Over how many days?
    • Yes:
    • No:
    • No pain:
    • Very minor pain:
    • Moderate pain:
    • Severe pain:
    • Not painful at all:
    • Very minor pain - less than I had expected:
    • Moderate pain - about what I had expected:
    • Extremely painful:
    • No injection given:
    • Superlative care:
    • Competent and caring:
    • Competent and uncaring:
    • Incompetent and caring:
    • Incompetent and uncaring:
    • Very satisfied:
    • Satisfied:
    • Dissatisfied:
    • Very satisfied:
    • Satisfied:
    • Dissatisfied:
Follow Bristol Endodontic Clinic on Twitter & Facebook!Like us on Facebook!Join our LinkedIn networkCheck out our YouTube channelFollow us on Twitter!Read our Blog!