Relocation Questionnaire - Caledonia Dental Practice Please let us have your thoughts on the proposed relocating of Caledonia Dental Practice by completing the short questionnaire below and submitting it to us. The consultation process will finish on 22nd March 2016.

Questionnaire

Proposal 1 : Re-location of Caledonia Dental Practice to Hathaway Medical Centre:

Yes

Proposal 2 : Caledonia Dental Practice to remain at New Road :

Yes

Please add any comments below which you would like considered as part of this consultation:

We would be grateful if you could provide the following information

as it will help us to know if we have received responses from a representative group of people:

Age Range:

Gender:

Ethnicity:

Do you consider yourself to have a disability?

Your Post Code: