John Leech MP's Dental Survey
Thank you for entering data into John Leech MP's Dental Survey. You can enter this survey either by using the mouse and drop down menus, or by typing in the responses using the numeric keypad. Throughout the survey for yes/no answers 0 = No and 1 = Yes. For answers with a series of options the drop down responses are listed numerically in the order the options appear on the form. To increase response accuracy, in sections where a particular response results in a jump to the next section (eg in question 6, 'if no go to Q15) the questions in between will not appear when inputting.
This survey can be completed by anyone living at this address. Please let us know which individual is completing it by filling in your details. All responses will be treated in confidence.Only overall results will be reported.
There are 35 questions in this survey.
Section 1
About You
Title
Mr, Mrs, Miss, Ms, Dr etc
Name
House and street
1 Barcicroft Road
Postcode
M19 1AB
Tel (h)
Only numbers may be entered in this field
01612345678
Tel (m)
Only numbers may be entered in this field
0789123456
Email
Section 2
You and your dentist
Are you registered with a dentist?
Choose only one of the following
0 = No
1 = Yes
No answer
Were you registered with an NHS dentist before the changes to the national dental contract on 1st April 2006?
Choose only one of the following
0 = No
1 = Yes
No answer
Do you have regular check ups?
Choose only one of the following
0 = No
1 = Yes
No answer
Do you know how to find an NHS dentist?
Choose only one of the following
0 = No
1 = Yes
No answer
How did you find your NHS dentist?
Choose only one of the following
1 Patient Advisory and Liason Services (PALS)
2 NHS Direct
3 MP/Local Councillor
4 Other (please specify below)
No answer
If you answered 'Other' to question five, please let us know how did you find your NHS dentist?
Have you tried to access treatment with a dentist within the last two years?
Choose only one of the following
0 = No
1 = Yes
No answer
Were you able to obtain NHS treatment?
Choose only one of the following
0 = No
1 = Yes
No answer
Was it with your usual dentist?
Choose only one of the following
0 = No
1 = Yes
No answer
How far did you have to travel to receive treatment?
Choose only one of the following
1 Under 1 mile
2 Between 1 and 3 miles
3 Over 3 miles
No answer
Were you treated by
Choose only one of the following
1 = An NHS dentist
2 = A private dentist
3 = Other
No answer
If you answered 'Other' to question ten, please let us know how how you received treatment?
If you have experience of both private and NHS treatment, can you indicate how the NHS treatment compared?
Choose only one of the following
1 Much Better
2 Better
3 Same
4 Worse
5 Much worse
No answer
Please rate your satisfaction with your treatment
Choose only one of the following
1 = Very Good
2 = Good
3 = Acceptable
4 = Poor
5 = Very Poor
No answer
How reasonable do you think the cost of your treatment was?
Choose only one of the following
1 = Very
2 = Quite
3 = Not Very
4 = Not at all
No answer
Did staff at the practice where you received treatment give you time and make you feel at ease?
Choose only one of the following
0 = No
1 = Yes
No answer
Does the dentist you have traditionally visited still offer NHS treatment?
Choose only one of the following
0 = No
1 = Yes
2 = I have not visited a dentist before
3 = Dont Know
No answer
Have you ever accessed emergency dental treatment at the Dental Hospital in Manchester?
Choose only one of the following
0 = No
1 = Yes
No answer
Were you satisfied with your service at the Dental Hospital?
Choose only one of the following
0 = No
1 = Yes
No answer
How long did you have to wait to be seen at the Dental Hospital?
Choose only one of the following
1 = Under 1 hour
2 = Between 1 and 2 hours
3 = Between 2 and 4 hours
4 = Longer
No answer
Section 3
About you (part 2)
Age
Choose only one of the following
1 = 0-17
2 = 18-35
3 = 36-59
4 = 60+
No answer
Excluding yourself, how many of the other people in your household are:
Check any that apply
1 = 0-17
2 = 18-35
3 = 36-59
4 = 60+
Which party would you be most likely to support if there was a General Election tomorrow?
Choose only one of the following
1 = Lib Dem
2 = Labour
3 = Conservative
4 = Lib Dem/Labour
5 = Lib Dem/Conservative
6 = Green
7 = Other
No answer
If you answered 'Other' to question 3, please let us know whichother party you support
Section 4
Helping out locally
Your local Lib Dem team are working hard for health services in your area. Can you help us to continue to work hard for the area by
Check any that apply
1 = delivering some leaflets?
2 = doing some clerical work?
3 = displaying a poster?
4 = I enclose a cheque for:
Please mark each entry that was ticked
How much?
Quote the amount in pounds sterling
Frequency of payment.
Choose only one of the following
1 = Single payment
2 = Per week
3 = Per month
4 = Per quarter
5 = Per year
No answer
If the querant has stated monthly, quarterly, yearly etc.
If the donation is over £ 10.00, does the querant wish to join the Liberal Democrats?
Choose only one of the following
0 = No
No answer
0 = no
Exit and Clear Survey
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