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Your Feedback

The Dental Complaint Service is committed to providing a high standard of service. To help us monitor and improve our level of service, it would be appreciated if you could take the time to complete and return this questionnaire. Please be assured that the information you provide will be treated in the strictest confidence.

Personal details (optional)

Name

Address

Postcode

Daytime Telephone No.

if you would like us to contact you with regards to the service that you have received please tick this box

Please rate the following:

	Excellent	Good	Average	Fair	Poor
Speed in which we responded to your enquiry
Overall attitude and courtesy of Complaints Officer(s)
Clarity of information
Recommendations offered
Quality of Service provided
Promised timescales met

if you would like to make a specific complaint, tell us about what we have done well, to comment or suggest improvements about our service, please click on proceed to add your comments

What is the nature of your feedback?

Complaint Officers name

Please use this space to tell us what you disliked about our service and how we can try to put things right

Please tell us about your complaint -Enter Details Here-

What action would you like us to take? -Enter Details Here-

Please use this space to let us know of any comments or suggestions you may have

Please enter any comments you have -Enter Details Here-

Please use this space to make any compliments you may have

Please use this space to tell us
anything we have done well or how
we can improve our service delivery -Enter Details Here-

Data Protection

The information you provide on this form will only be used for the purpose for which it has been given and will not be used for anything else without your consent. All personal data is collected and processed in compliance with the Data Protection Act 1998.