NHS Feedback form | Bluebell Dentistry | NHS Dental Practice The NHS Family and Friends Test We Would like you to think about your recent experiences of our service 1. 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 Think about your response to this question, what is the main reason you feel this way? A little bit about you: 2. Are you ? Male Female 3. What age are you 0-15 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ 4. Do you consider yourself to have a disability? Yes No 5. Which of the following describes your ethnic background? White British Irish Other White background Asian or Asian British Indian Pakisthani Bangladeshi Chinese Other Asian background Mixed White and Black Carribean White and Black African White and Asian Other Mixed background Black and Black British Carribean African Other background Other Anything else I would rather not say 6. Are you ? The patient The parent or carer The patient and carer Please tick here if you DO NOT wish your anonymous comments to be shared Please enter verification code listed on right, in order to process the form: Submit
