Patient Feedback

Fields marked with a * are mandatory

Patient Feedback

Please select your treating clinician: *
Dr Sheila ChauhanDr Nadia HikmatLisa BruchAngela Gadaleta

Do you feel your received a warm welcome at the practice?: *
YesNo

Please indicate if you are receiving treatment at the practice or whether you are the responsible person for someone else receiving treatment here at the practice: *
I am receiving treatmentI am the responsible adult for someone else receiving treatment

Do you feel informed in advance of the treatment planned: *
YesNo

Did you understand the consent document you received and signed prior to the start of your treatment: *
YesNo

What is your observation as to the level of cleanliness in the waiting room: *

Do you feel you are treated with respect whilst visiting the practice: *
YesNo

Do you feel that patient confidentiality is well respected within the practice: *
YesNo

Do you feel safe whilst you are on our premises: *
YesNo

Are you aware that we have had our initial CQC inspection and passed in all areas on your first visit : *
YesNo

Are you aware of our BDA good practice accreditation: *
YesNo

If yes to the above question what does that mean to you:

What further information would you like to see in your waiting room:

Would you recommend the practice to your friends and family: *
YesNo

Please type the letters/numbers shown below to prove you are human: *