Name of the clinic
Address of the clinic
Postcode, city, (and country, if outside UK)
Name of the treatment provider
Name of the treatment
Date of the treatment
1. What is your overall impression of the clinic and the treatment course?
Reason/comment:
2. How would you rate the cosmetic result of the treatment, compared to, what the treatment provider told you to expect?
3. How would you rate the level of reassuring information, advice, and guidance given to you before and during the course of the treatment?
4. How was the clinic's general level of service and customer care?
Name:
Address:
Postcode and city:
Date of birth: 12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
E-mail:
Discretion: In the case of any errors or missing information, Mylooks should:
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In order to publish anonymous reviews, Mylooks will need to know the identity of the person submitting the review. The information is stored confidentially and will not be shown on Mylooks or passed along to others. The information is used exclusively to confirm the genuineness of the submitted review, in order to prevent misuse of the system. Read more about Mylooks' privacy policy here
