Wedgwood House Dental Practice

Electronic-based Patient Questionnaire

Dear Sir or Madam,

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.

We would like you to think about your recent experiences of our practice...

Thank you,

Dr Jill Geaney and her staff

Wedgwood House Dental Practice

100 Bury Street, Stowmarket, IP14 1HF

Your form message has been successfully sent.

You have entered the following data:

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).

Please correct your input in the following fields:

Error while sending the form. Please try again later.

Name: *

Date of attending the practice *

Date of Birth *

E-mail address: *

Telephone no.

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

Are you a Private or NHS customer? *

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) *

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

Captcha (spam protection code): *

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.

Note: Fields marked with * are required

Address

Dr J. M. Geaney

Wedgwood House Dental Practice

Bury Street 100, Stowmarket, IP14 1HF

Our new website tells you all about our services. If you want to get in touch with us, phone us on +44 (0)1449 771 700 to make or update an appointment.

In this practice we take complaints very seriously and try to ensure that all our patients are pleased with their experience of our service. Should you have a complaint, then please FIRST write to Dr J M Geaney the practice Proprietor.

Tweet this page

Fill out my online form.

Online contact and registration forms from Wufoo.

Web View Mobile View

Logout Edit page