Which Clinic should I choose? Form

Which Clinic should I choose? Form
We want to help you find the best dentist possible for your needs, really!
Its not good for business to have our patients unhappy.
Thats why we need some info from you first, then we can see which Drs match your criteria.
Heres the form we can send you if you request help choosing a dental clinic:
Enquiry Form Example

Number Of People Needing Treatment:__  (if more than 1, please submit one form per person)
About Yourself:
What Factors Are Most Important To You On Your Dental Tour?:
Latest Equipment and Techniques used  
Ease of Booking and Transportation to clinic 
Strong English skill by Dr and staff 
Friendliness of staff and Dr
Follow Up Support 
Atmosphere of Clinic
Appearance of Clinic 
Doctors with Many Years of Experience 
Must have had good Feedback from other foreigners already
Doctor must be a Foreigner or Studied in a Western country.
Must be a Large clinic
A Relaxing Holiday, with some dental thrown in

If you have serious Health Problems, what are they?_________
What previous major dental work have you had done before?________
Please Attach X-ray of Jaw (needed for complicated surgery or implants) : 
you can request an OPG from your hospital which is panoramic X-ray of your jaw and teeth.
Then they or you can forward the image file to us - contact@hcmcdental.com
or if you have the file on your computer select the files below.
If you have the hard copy of the X-rays , you can hold up the X-ray to the light and send a clear focused photo, but a digital file would be better.

What procedures do you require?
Scale and Polish
Tooth Restoration
Teeth Laser/Gel Whitening
Tooth Extraction
Root Canal work 
Other -______________________________________
Length of Stay in Saigon _____
Do You Need Accommodation? 
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