1.We would like you to think about your recent experience of our service.
How likely are you to recommend our dental practice to friends & family, if they needed similar care or treatment?

Extremely likely

Likely

Neither likely or unlikely

Unlikely

Extremely likely

Don't know

2.Thinking about your response to this question, what is the main reason why you feel this way?

A little bit about you....

3.Are you male or female?

Male

Female

4.What age are you?

0-15

16-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

5.Do you consider yourself to have a disability?

Yes

No

6.Which of the following best describes your ethnic background?

White - British

White - Irish

White - Other background

Black or Black British - Caribbean

Black or Black British - African

Black or Black British - Other Black background

Asian or Asian British - Indian

Asian or Asian British - Pakistani

Asian or Asian British - Bangladeshi

Asian or Asian British - Chinese

Asian or Asian British - Other Asian background

Mixed - White & Black Caribbean

Mixed - White & Black African

Mixed - White & Asian

Mixed - Other Mixed background

Other

7.Are you?

The patient

The parent or carer of patient

The patient & parent/carer

Thank you for taking the time to complete this survey & to help improve our services.