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Private Referral Form

Patient Care Feedback Form

We are always grateful to receive your comments about your experiences with Rectory House Dental Practice. Whether it's good or bad, a complaint or praise we do benefit from listening to you, so that we can improve what we do.

We have a personal commitment to making your experience of Rectory House Dental Practice both enjoyable and memorable for the right reasons. We can't promise we will always be able to satisfy your every need but we will act quickly to rectify any issue you may encounter.

Patient Feedback Form

First name:
Please complete our form and tick one box to indicate the following:
1= Strongly Agree or 4 = Strongly Disagree
1. Do we answer the phone promptly and politely?
2. Do you feel that clinical and nursing staff explain themselves well?
3. Do we see you on time?
4. Is our reception area clean and comfortable?
5. In an emergency, is it easy for you to get in touch with our practice?
6. Are you greeted pleasantly upon arrival?
7. Do you feel the dentist, hygienist and nursing staff are attentive to
your needs and concerns?
8. Do our staff spend adequate time with you?
9. Are you referring your friends and colleagues to our practice?
If not, please let us know why?
10. Are you pleased with the results you are seeing?
If no, please let us know why?
11. Is our practice easy to find?
12. What do you like or dislike most about our practice?


13. What would make your experience at our practice even better?
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Last update: Thursday, 4th June 2019
© 2018 Rectory House Dental Practice
Eng Ref No. 6884406