26 Market Square, Witney, OX28 6BB enquiries@witneydentalpractice.co.uk

Patient Feedback Form

Dear Patient,

At Witney Dental Practice, we place great importance on ensuring that the quality of care and service you receive is of the highest possible standard.

Asking patient for their views on the care and treatment provided by the practice team is an important part of our accreditation programme.

Your feedback is important to us, so please take a few moments to complete this questionnaire. You can also complete the questionnaire at the practice and hand it back to our receptionist.

All responses will be treated in confidence

Thank you very much in advance for your time and assistance.

Yours sincerely

Your feedback

Please click the appropriate box

How would you describe the general level of comfort and freedom from pain in your mouth?
Generally, and as far as your teeth and mouth are concerned, how would you describe your ability to eat just about anything you like?
Generally, how would you describe the appearance of your teeth (including any false teeth)?
How would you rate the competence of your dental team?
How would you rate the standard of cleanliness and hygiene at your dental practice?
How would you describe the attitude of the dental team towards you?
How would you rate the ability of your dental team to understand your needs?
How would you describe the value for money given at your practice?
How would you rate the level of trust that you feel in your dental team?

Please give a score out of 10 where 0 = Not at all likely 10 = Extremely likely

About you

What type of patient are you?
Are you
What is your age?

or age of the child you are responding on behalf of

Contact The Practice

26 Market Square, Witney, OX28 6BB · Tel 01993 702415