patient feedback form

Dear Patient,

We would be grateful if you could answer the following questions about your recent visit to our surgery:

How was our welcome when you arrived for your appointment?
How clean did you find the Practice?
Did you see the dentist/hygienist on time?
While in the surgery did you feel as comfortable/relaxed as you could be?
Did you understand everything that was explained to you by the dentist/hygienist?
Did we meet your expectations and fulfil your reasons for coming?

Can we use your comments in our marketing material?
Many thanks,
Practice Manager.

183 Petts Wood Road,
Petts Wood,
Orpington BR5 1JZ.

  • Tel: 01689 897901.
  • E-mail receptionE-mail:

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Site last updated 20 May 2019