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Which dental practice did you visit?

How likely are you to recommend our dental practice to friends and family if they needed similar care or treatment?
 Extremely likely Likely Neither likely or unlikely Unlikely Extremely unlikely Don't know

Thinking about your response to this question, what is the main reason why you feel this way?

Are you?
 Male Female

What age are you?
 0-15 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Do you consider yourself to have a disability?
 Yes No

Which of the following best describes your ethnic background?

White

 British Irish Other white background

Black or Black British

 Caribbean African Other Black Background

Asian or Asian British

 Indian Pakistani Bangladeshi Chinese Other Asian background

Mixed

 White and Black Caribbean White and Black African White and Asian Other Mixed Background

Other

 Anything else I would rather not say

Are you?
 The patient The patient or carer The patient and parent/carer


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