Female No Does not apply, I am not an NHS patient Question 23: Question 27: What was your age at your last birthday? Do you go to the dentist: Regularly for check-ups? years Only if you have a problem or pain? Question 24: Question 28: Are your day-to-day activities limited by any How would you rate your overall dental health problem or disability which has lasted, health? or is likely to last, more than 12 months? Extremely limited Excellent Limited a lot Good Limited a little Fair Not at all limited Poor Question 25: Question 29: Why did you choose to come to this practice How long did it take you to reach the for your dental care? practice from home/work today? Dental Helpline referred me I always come to this practice hours minutes The practice has a good reputation I have a dentist didn’t I needed emergency care How did you travel to the practice today (e.g. bus, car, foot, etc)? Other (please describe below): in):___________________________ Thank you for taking the time to complete this questionnaire
Female No Does not apply, I am not an NHS patient Question 23: Question 27: What was your age at your last birthday? Do you go to the dentist: years Regularly for check-ups? Only if you have a problem or pain? Question 24: Question 28: Are your day-to-day activities limited by any health problem or disability which has lasted, or is likely to last, more than 12 months? How would you rate your overall dental health? Extremely limited Excellent Limited a lot Good Limited a little Fair Not at all limited Poor Question 25: Question 29: Why did you choose to come to this practice for your dental care? How long did it take you to reach the practice from home/work today? Dental Helpline referred me hours minutes I always come to this practice The practice has a good reputation I didn’t have a dentist I needed emergency care How did you travel to the practice today (e.g. bus, car, foot, etc)? Other (please describe below): in):___________________________ Thank you for taking the time to complete this questionnaire
February_2014_NHS_Dental_Services_PEQ.docx