We appreciate you taking the time to complete our survey.

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* 1. Which Dentist do you usually visit?

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* 2. How satisfied were you with the time you had to wait to book an appointment to see Dr Davison? If dissatisfied please explain below:

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* 3. How long do you wait to be seen for your appointment with Dr Davison?

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* 4. Did you have sufficient anaesthetic for your treatment?

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* 5. Was Dr Davison attentive to your needs?

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* 6. How satisfied were you that Dr Davison involved you in decisions about your dental care? If dissatisfied please explain below:

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* 7. How satisfied were you with the information given by Dr Davison on the cost of your treatment? If dissatisfied please explain below:

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* 8. During your most recent visit, did Dr Davison explain things in a way that was easy to understand? Then move to Question 26.

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* 9. How satisfied were you with the time you had to wait to book an appointment to see Dr Stannard? If dissatisfied please explain below:

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* 10. How long do you wait to be seen for your appointment with Dr Stannard?

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* 11. Did you have sufficient anaesthetic for your treatment?

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* 12. Was Dr Stannard attentive to your needs?

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* 13. How satisfied were you that Dr Stannard involved you in decisions about your dental care? If dissatisfied please explain below:

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* 14. How satisfied were you with the information given by Dr Stannard on the cost of your treatment? If dissatisfied please explain below:

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* 15. During your most recent visit, did Dr Stannard explain things in a way that was easy to understand?

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* 16. How clean were the areas in which you were treated at holistic dental centre?

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* 17. Who was your Hygienist?

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* 18. Were you treated with dignity and respect by your hygienist?

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* 19. Did your hygienist try their best to make you feel as comfortable as possible, if not please explain what we could change?

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* 20. Do you feel an improvement as a result of your hygiene treatment?

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* 21. Using any number from 0 to 4, where 4 is the most painful and 0 is pain free, what number would you use to rate your last hygienist appointment?

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* 22. Who was your dental nurse?

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* 23. Were you treated with dignity and respect by your dental nurse?

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* 24. Was your dental nurse attentive to your needs? (e.g. suctioning away saliva when necessary)

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* 25. How did you find the atmosphere in the surgery, please tick all that apply

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* 26. Were your clothes sufficiently protected from materials and moisture?

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* 27. If your jaw felt tired during treatment, was care taken to make you more comfortable?

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* 28. If you had to spend more than 15 minutes in the waiting room before you saw someone for your appointment, how often did someone tell you why there was a delay or how long the delay would be?

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* 29. Were you greeted with courtesy and respect when you entered the practice?

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* 30. How respectful of your cultural commitments was the staff at holistic dental centre?

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* 31. How confident are you that your dental team listens and responds to your needs?

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* 32. How confident are you that your personal information is kept confidential and secure at the practice?

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* 33. Following on from previous feedback, and the waiting times to book a hygienist appointment; we now have an experienced hygienist who works with us when Jackie, Nav and Denise are on vacation.  Do you have any views or thoughts on being treated by another hygienist?

  4 Excellent Service 3 2 1 0 Worst Service
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* 34. Using any number from 0 to 4, where 0 is the worst dental care possible and 4 is the best dental care possible, what number would you use to rate all of the dental care you personally received in the last 12 months?

  4 3 2 1 0 Worst regular dentist possible
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