Patient Feedback Form THE NHS FRIENDS AND FAMILY TEST We would like you to think about your recent experience of our service 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? A little bit about you: 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 Details: Which of the following best describes your ethnic background? White British Irish Other white background Asian or Asian British Indian Pakistani Bangladeshi Chinese Other Asian background Mixed White and Black Caribbean White and Black African White and Black Asian Other Mixed Background Black or Black British Caribbean African Other Black Background Other Anything else I would rather not say Are you? The patient The parent or carer The patient and parent/carer Thank you for completing the card and providing us with feedback to improve our services. if you DO NOT wish your anonymous comments to be shared then please tick here: Tick Register Now Book Online Facebook Vita Dental Spa Latest Tweets Tweets by @VitaDentalSpa Appointments Tel: 01382 530060 Email: firstname.lastname@example.org You can also use our contact form. Address Vita Dental Spa 26 -28 High Street Monifieth Dundee DD5 4AE Opening hours Mon 9am - 5.30pm Tue 9am - 7.30pm Wed 11am - 7.30pm Thur 9am - 5.30pm Fri 9am -5.30pm Sat 9am - 5pm If you have a problem outside our opening hours, please see the emergency plan.