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

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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

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3

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

Yes

No

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4

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

Least Likely

Extremely Likely

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