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Patient Feedback Form

First Name: First name required.
Surname: Surname required.
Email: Email required.Invalid format.
1= Strongly Agree or 4 = Strongly Disagree
1. Do we answer the phone promptly and politely?
2 3 4
2. Do you feel that clinical and nursing staff explain themselves well?
2 3 4
3. Do we see you on time?
2 3 4
4. Is our reception area clean and comfortable?
2 3 4
5. In an emergency, is it easy for you to get in touch with our practice?
2 3 4
6. Are you greeted pleasantly upon arrival?
2 3 4
7. Do you feel the dentist, hygienist and nursing staff are attentive to your needs and concerns?
2 3 4
8. Do our staff spend adequate time with you?
2 3 4
9. Are you referring your friends and colleagues to our practice?
If not, why?
No
10. Are you pleased with the results you are seeing?
No
11. Is our practice easy to find?
No
12. What do you like or dislike most about our practice?  
Like  
Dislike  
13. What would make your experience at our practice even better?
 
 

Colchester Dental Referral Centre
841 The Crescent
Colchester Business Park
Colchester
CO4 9YQ

Tel: 01206 756 813
Fax: 01206 854 767