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Your Name
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Email
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Phone
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Approximately how long after your scheduled appointment time did you have to wait to be seen?
I was seen at the time of my appointment
i waited 5 - 10 minutes
i waited 10-15 minutes
i waited longer than 20 minutes
Were you given an explaination for the delay?
Yes
No
If our opening days/ hours do not suit you, what days / hours would be more convenient?
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How satisfied were you with the following, please tick where appropriate.
Very Satisfied
Satisfied
Dissatisfied
Very dissatisfied
Manner in which you were welcomed
Cleanliness of the practice
Dentist's ability to listen to you
Dentist's ability to convey information About you oral health
Dentist's ability to convey treatment Options
Details of prices and payment options
Your questions being answered
Thinking of your entire visit, what stands out as most positive with us?
What one thing could have made your visit a better one?
Do you have any comments you wish to make?
Would you be happy to be contacted to find out more about what you think of our services and their suggestions for improvement?
Yes
No