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Duston Dental Practice Satisfaction Survey 2016
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1.
Question 1.
Please indicate your age range
0-18
19-24
25-34
35-44
45-54
55-64
65+
2.
Question 2.
Please indicate your gender
Male
Female
Other
3.
Question 3.
How long have you been a patient at Duston Dental Practice?
First visit
0-6 months
6-12 months
12 months+
4.
Question 4.
How did you hear about Duston Dental Practice
Personal recommendation
Duston Dental Practice website
Internet search engine
Telephone directory
Other (please specify):
This is required
Input box for - Other (please specify):
5.
Question 5.
Which dentist or hygienist do you normally see (tick all that apply)?
Andrew Lamb
Richard Staincliffe
Cerys Williams
Fiona Shackleton
Megan Cross
Rakhee Shah
Priyesh Patel
Nilesh Patel
Amarat Bal
Linda Ryder
Sarah Twelftree
6.
Question 6.
How would you rate the following aspects of your most recent visit to Duston Dental Practice?
Excellent
Good
Adequate
Poor
Very poor
Helpfulness of reception staff
Excellent
Good
Adequate
Poor
Very poor
Helpfulness of nursing staff
Excellent
Good
Adequate
Poor
Very poor
Pain control
Excellent
Good
Adequate
Poor
Very poor
Care and attention shown by your dentist
Excellent
Good
Adequate
Poor
Very poor
Explanation of treatment costs and options
Excellent
Good
Adequate
Poor
Very poor
Practice opening hours
Excellent
Good
Adequate
Poor
Very poor
Availability of routine appointments
Excellent
Good
Adequate
Poor
Very poor
Availability of emergency appointments
Excellent
Good
Adequate
Poor
Very poor
Waiting time for your scheduled appointment
Excellent
Good
Adequate
Poor
Very poor
Practice hygiene
Excellent
Good
Adequate
Poor
Very poor
Building access
Excellent
Good
Adequate
Poor
Very poor
7.
Question 7.
Are there any other comments which you would like to make about Duston Dental Practice?