Name: Wedgwood House Dental Practice
Address: 100 Bury Street, Stowmarket
Telephone: 01449771700

Patient Feedback Questionnaire (Online Version)

Dear Patient,

Our mission is to ensure our customers have lasting, healthier and happier smiles. It is important that we know your views on the dental practice and the care we provide and to record your opinions on where we can improve. We would be grateful if you would spend a few minutes completing this form.

Thank you,

Dr Jill Geaney and her staff

Wedgwood House Dental Practice
100 Bury Street, Stowmarket, IP14 1HF

If you would like to write directly to Dr Jill Geaney to provide feedback rather than use this web form, please feel welcome.
Email to jill.geaney@nhs.net (Subject field: Patient Feedback).

Name*

This field is mandatory

Date of attending the practice:*

This field is mandatory

E-mail address:*

This field is mandatory

Telephone number:

Optional: Name(s) of staff feedback relates to:

Was your appointment for NHS or private treatment?*

This field is mandatory

I consent for my feedback to be used on Wedgwood House's public website and in-practice literature. (Unticked, your comments will not be made public).

Feedback relates to Reception staff

Feedback relates to Dentist or Hygienist staff

Feedback relates to Nursing staff

Feedback relates to other

I am a patient of WHDP and this feedback is based on my recent experience

How likely are you to recommend us to friends and family if they needed similar care or treatment? (Extremely Likely, Likely, Neither Likely or Unlikely, Unlikely, Extremely Unlikely, Don't know).*

This field is mandatory

Please tell us the main reason for the statement you have selected.*

This field is mandatory

I am over 18 years of age and a UK citizen. I hereby agree that my personal data entered in the Patient Questionnaire Form will be stored electronically by Wedgwood House Dental Practice, and will be processed and used for the purpose of measuring patient satisfaction. I agree that NHS related feedback will be forwarded to the NHS Friends and Family Test scheme. I am aware that all information can be shared with the Care Quality Commission (CQC). I am aware that I can revoke my consent at any time in accordance with the UK Data Protection Act 2018, unless that feedback requires consultation with third parties such as defence unions. The dental practice reserves the right to exclude vindictive or malicious feedback and inappropriate feedback from ex. (inactive) patients.*

* Indicates required fields

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