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 Likely Likely Neither Likely or Unlikely Unlikely Extremely Unlikely Don'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?

 Male Female

What age are you?

 0 - 15 16 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Do you consider yourself to have a disability?

 Yes No

Details:

Which of the following best describes your ethnic background?

White

 British Irish Other White Background

Asian or Asian British

 Indian Pakistani Bangladeshi Chinese Other Asian Background

Mixed

 White and Black Caribbean White and Black African White and Asian Other Mixed Background

Black or Black British

 Caribbean African Other Black Background

Other

 Anything Else I Would Rather Not Say

Are you?

 The Patient The Parent or Carer The 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: