Patient Feedback Form

1

How many times have you used Bradford-on-Avon Dental Practice in the past year?* This field is required.

Never

1-3 Times

4-10 Times

More than 10 Times

2

If Bradford on Avon Health Centre were to move within 1.9 miles would you stay with the practice?* This field is required.

Yes

No

3

Do you have a disability which means you have/ would have difficult accessing services at BA15 1DE?* This field is required.

Yes

No

4

Would you recommend friends and family to join the new dental practice? * This field is required.

Least Likely

Extremely Likely