Castle Hill Clinic in Reading, Berkshire: chiropody, hypnotherapy, podiatry, chiropractic, dentistry in Reading: Reading chiropody, Reading podiatry, Reading hypnotherapy, Reading hypnotist, Reading chiropractic, Reading dentistry, Reading hypnotherapist, Reading chiropodist, Reading chiropractor

1) Age

Under 18

18 - 30

31 - 45

46 - 60

61 +

2) Gender

Male

Female

3) How often do you go to the dentist for check-ups?

Every 6 months

Once a year

Once every 2 years

Occasionally

Only when I have a problem

4) What was the purpose of your last visit?

Hygiene

Crown or Bridge

Facial Rejuvenation

Implant

Root Canal

Filling

Other

5) Which dentist did you see?

Rajan Sharma

Shivani Sharma

Somit Prasad

Margarita Kyrou

Saffina Nanji

Kendal Williamson - Hygienist

6) Date of last visit:

7) Dentist	Excellent	Good	Fair	Poor	N/A
Listens to you:
Takes enough time with you:
Clearly answers all your questions:
Comments

If you answered 'fair' or 'poor' please provide further information:

10) Would you refer us to your friends and family?

Yes

Maybe

Name (You can return this anonymously if you prefer)

Date:


	Castle Hill Clinic 1c Tilehurst Road Reading RG1 7TW Tel: 0118 958 6766