Community Dental Service 2019 The future of Community Dental Services in Leeds You can tell us what you think about our proposed changes to Community Dental Services by filling in this short questionnaire. OK Question Title * 1. Are you completing this questionnaire as a… A new patient who has been referred but not had an appointment yet Existing patient of community dental services Carer / parent of a patient who uses community dental services A member of the public A referrer to community dental services A member of staff at Leeds Community Healthcare Other (please specify) OK Question Title * 2. If you are an existing patient (or carer of an existing patient) where do you currently go to receive community dental care? (tick all that apply) Armley Moor Health Centre Beeston Community Clinic Chapeltown, The Reginald Centre Middleton Health Centre Yeadon Clinic OK Question Title * 3. Do you understand why Leeds Community Healthcare (LCH) wants to change the way it provides Community Dental Services? Yes No OK Question Title * 4. When would you prefer your dental appointment to be? (you can tick more than one) Weekday mornings between 7am and midday Weekday afternoons between 1pm and 4pm Weekday early evenings between 4pm and 6pm Saturday mornings between 9am and1pm OK Question Title * 5. Is there anything else you would like to say about the proposed service improvements? OK Question Title * 6. Please tell us your postcode OK Question Title * 7. Are you White Mixed/multiple ethnic groups Asian/British Asian Black/Black British Another ethnic origin (please specify) OK Question Title * 8. Are you Female Male Transgender Prefer not to say OK Question Title * 9. Are you a disabled person Yes No OK Question Title * 10. Please tell us your age Under 18 18-24 25-34 35-44 45-54 55-64 65+ OK THANK YOU FOR TAKING THE TIME TO LET US KNOW WHAT YOU THINK. WE REALLY VALUE YOUR FEEDBACK.