Please give us your valuable feedback

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* Please write how much you agree with each of the questions below

  Highly Agree Agree Not sure Disagree Highly Disagree
The information available to me (for example, in leaflets at reception) cover all that I need to know about using the practice's services and looking after my dental care
I'm usually able to book appointments at times that suit me
When I have to pay for services, I believe the practice provides fair value for money
it's easy for me to enter and move around the building
The reception, treatment room and other parts of the practice are always clean, comfortable and tidy
Whenever I want to talk about anything privately I am able to do so in a quiet area
I always feel well treated when I call to make an appointment or visit
I have confidence in the knowledge and abilities of the dentists, hygienists and others involved in providing my dental care
I'm always treated with dignity, gentleness and care by the dentist and others
My opinion is always taken into account when my treatment options are being discussed and agreed
I felt the reception team dealt with my requirements politely and efficiently
The nurse I saw was friendly, informative and helpful

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* I was kept waiting beyond the time of my appointment:

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* The dentist/hygienist talked to me about ways that I can prevent gum or tooth problems:

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* I would know how to make a complaint about my treatment today if I needed to:

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* The dentist/hygienist explained treatment options and prices before offering treatment:

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* I knew how much I would have to pay for treatment before I started it:

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* Was your treatment:

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* Was your treatment:

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* My dentist's name is:

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* Please score how likely you would be to recommend our practice to another person (1 being unlikely and 10 being highly likely):

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* Please briefly say why you chose this score:

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* Comments and suggestions:

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* Date of survey:

Date

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