New Practice Survey

We are currently bidding to provide dental services in Southampton. Please help us to design a practice to suit your needs.

Questionnaire

1) Can I ask your age group?
16-20     21-30     31-40     41-50     51-60     60+
2) Do you currently access dental services regularly? If so, where?
3) If you answered yes to the above question, which of our proposed locations would be more convenient for you?
Location A (Redbridge)     Location B (Shirley)
4) Do you think an NHS dental practice would be beneficial in that area?
Yes     No
5) If an 8-8 service was open 7 days a week, would you use it? If yes, why?
Yes     No
6) If one of the locations was converted into a dental practice, how would you rate its location against dental practices you may have visited?
7) Dental Health Needs
Would you like access to additional smoking cessation advice? Yes     No
Would you like alcohol intake advice? Yes     No
Would you like oral health and hygiene advice? Yes     No
Would you like to be able to see a dental therapist or dental hygienist? Yes     No
8) Would you like to be contacted if we are successful in our tender bid? If yes, please provide us your details.
Yes     No
Name:

Telephone:

Email:

Thank you for your valued feedback. Please be assured that we will use this feedback to develop our services in the future. Your right to privacy will be respected and adhered to.