Through this survey, Healthwatch Cumbria wants to find out what effect not having an NHS dentist has had on people who live in and around Cleator Moor.

The information gathered as part of the survey is confidential, will only be used for this project, and viewed by those staff directly involved. The analysis of responses will not contain any personal identifiable information.

If you are interested in participating further in the project there is the opportunity for you to provide your email address or other contact details at the end of the survey, but this is optional.

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* 1. What is the first part of your postcode?

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* 2. Do you have an NHS dentist?

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* 3. When were you last treated by an NHS dentist?

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* 4. Where was this treatment?

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* 5. How far have you travelled to receive NHS dental treatment?

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* 6. Have you received other dental treatment?

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* 7. Is there anything you would like to tell us about this?

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* 8. How has not being treated by an NHS dentist affect you or your family? Things to think about include:

· Because of a medical condition you were unable to take painkillers and experienced painful toothache.
· An untreated dental issue led to hospitalisation or trying to remove teeth yourself. 
· Ill-fitting dentures or broken fillings led to an ulcer, bleeding gums or infection. Perhaps you struggled to eat and speak, or lack of dental care affected your self-confidence and mental health.
· Your child was ill and in pain because they were not treated.
· You had to telephone lots of different practices directly to try and find an NHS dentist.

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* 9. How old are you?

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* 10. Are you:

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* 11. What is your ethnicity?

Thank you for taking the time to complete this survey.

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* 12. If you would like to tell us more about your experience, please leave your contact details here and a Healthwatch Cumbria member of staff will be in touch. (This is optional.)

HWC is delivered by People First Independent Advocacy Registered Charity and Company Limited by Guarantee (Registered Charity No. 1184112 Company No. 5438407)

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