Thank you for visiting us. To help us improve our services, please complete this short questionnaire so that we can make things even better at your next visit. Please tick the answer that best matches your view.

* 1. Your Name:

* 2. Approximately how long after your scheduled appointment time did you have to wait to be seen?

* 3. If our opening days/ hours do not suit you, what days / hours would be more convenient?

* 4. How satisfied were you with the following, please tick where appropriate.

  Very Satisfied Satisfied Dissatisfied Very dissatisfied
Manner in which you were welcomed
Cleanliness of the practice
Dentist’s ability to listen to you
Dentist’s ability to convey information
About you oral health
Dentist’s ability to convey treatment options
Details of prices and payment options
Your questions being answered

* 5. How long have you been a patient at this practice?

* 6. Do you have any comments you wish to make?

* 7. What one thing could have made your visit a better one?

* 8. Would you be happy to be contacted to find out more about what they think of our services and their suggestions for improvement?