Friends And Family Test

The NHS Friends and Family Test

We would like you to think about your recent experience of our service.

How likely are you to recommend our dental practice to friends and family if they needed similar care or treatment?

    Extremely LikelyLikelyNeither Likely or UnlikelyUnlikelyExtremely UnlikelyDon't Know

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

    A Little Bit About You:

    Are you?

    MaleFemale

    What age are you?

    0 - 1516 - 2425 - 3435 - 4445 - 5455 - 6465 - 7475 - 8485+

    Do you consider yourself to have a disability?

    YesNo

    Details:

    Which of the following best describes your ethnic background?

    White

    BritishIrishOther White Background

    Asian or Asian British

    IndianPakistaniBangladeshiChineseOther Asian Background

    Mixed

    White and Black CaribbeanWhite and Black AfricanWhite and AsianOther Mixed Background

    Black or Black British

    CaribbeanAfricanOther Black Background

    Other

    Anything ElseI Would Rather Not Say

    Are you?

    The PatientThe Parent or CarerThe Patient and Parent/Carer

    Thank you for completing the card and providing us with feedback to improve our service.

    If you DO NOT wish your anonymous comments to be shared then please tick here:

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