You have been invited to take part in this survey to improve the quality of care we provide to our patients. Your answers will remain completely anonymous and will not affect any future care or treatment.  Thank you for taking the time to complete the survey.

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1. Are you? (Required.)

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2. Which category below includes your age? (Required.)

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3. What were the reasons for having your orthodontic and surgical treatment? (Required.)

  Strongly Agree Agree Undecided Disagree Strongly Disagree
To improve my self confidence
To improve my looks
To improve my smile
To improve my social life
To straighten my teeth
To prevent future problems with my teeth
To improve my ability to eat
To improve my speech

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4. Were you ever teased about your appearance? (Required.)

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5. Were you ever embarrassed about eating in public? (Required.)

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6. Did you ever have difficulty eating? (Required.)

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7. Did you ever avoid smiling in photographs? (Required.)

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8. Were you ever self-conscious about the appearance of your teeth? (Required.)

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9. Were you ever self-conscious about your facial appearance? (Required.)

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10. Did you receive any information leaflets on braces? (Required.)

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11. If yes, did you find these leaflets useful?

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12. Did you receive any information leaflets on jaw surgery? (Required.)

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13. If yes, did you find these leaflets useful?

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14. Did you visit the BOS website (www.yoursurgery.com) about braces and jaw surgery? (Required.)

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15. If yes, did you find the website useful?

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16. Do you feel you were given enough information to help you make a decision about having treatment with regard to: (Required.)

  Strongly Agree Agree Undecided Disagree Strongly Disagree
Wearing braces
Duration of treatment
Wearing retainers
Surgery
Possible complications involved with treatment

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17. Which jaw did you have moved in surgery? (Required.)

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18. Was your operation cancelled and moved to another date? (Required.)

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19. Did you have to have a second unplanned operation after your jaw surgery (Reoperation/Revision Surgery)? (Required.)

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20. What do you feel were the benefits you received from the treatment? (Required.)

  Strongly Agree Agree Undecided Disagree Strongly Disagree
Increased my self confidence
Improved my facial appearance
Improved my smile
Improved my social life
Straight teeth
Prevented future problems with my teeth
Improved my ability to eat
Improved my speech

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21. Do you still have any of the following problems from your treatment? (Required.)

  Strongly Agree Agree Undecided Disagree Strongly Disagree
Difficulty eating
Numbness
Dental problems

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22. Do the problems you have listed in Question 21 effect you on a daily basis? (Required.)

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23. Do you feel the Specialist Orthodontist: (Required.)

  Strongly Agree Agree Undecided Disagree Strongly Disagree
Listened to what you had to say?
Gave you enough time to fully discuss your treatment?
Explained the reasons for your treatment in a way that you could understand?

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24. Do you feel the Specialist Surgeon: (Required.)

  Strongly Agree Agree Undecided Disagree Strongly Disagree
Listened to what you had to say?
Gave you enough time to fully discuss your treatment?
Explained the reasons for your treatment in a way that you could understand?

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25. Would you recommend this treatment to other people in your situation? (Required.)

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26. Which hospital did you have your braces fitted? (Required.)

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27. Would you recommend York Hospital to your family and friends?

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28. Would you recommend York Hospital for surgery?

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29. What, if anything, did we do well?

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30. What, if anything, could we do to improve our service in the future?

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