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Dental Attitudes Survey
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Do you currently have dental insurance for yourself?
Yes
No
Clear selection
If you do have dental insurance for yourself, how much of your dental bill is typically covered?
Less than 25%
26-50%
51-75%
more than 75%
Clear selection
Do you get the dentist recommended cleaning every six months for yourself?
Always
Sometimes
Never
Clear selection
If you answered sometimes or never, please rank the following reasons: I Cant Afford It
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If you answered sometimes or never, please rank the following reasons: I Don't Want to Hear That Painful or Expensive Work Will be Needed
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If you answered sometimes or never, please rank the following reasons: I'm Too Busy or Distracted to Make the Appointments
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If you answered sometimes or never, please rank the following reasons: The Dentist Lectures Me, or Doesn't Explain Things in a Way I Understand
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
Do you currently have dental insurance for all of the children in your home?
Yes
No
Clear selection
If the children in your home do have dental insurance, how much of their dental bill is typically covered?
Less than 25%
26-50%
51-75%
more than 75%
Clear selection
Do you get the dentist recommended cleaning every six months for the children in your home?
Always
Sometimes
Never
Clear selection
If you answered sometimes or never, please rank the following reasons: I Don't Want to Hear That Painful or Expensive Work Will be Needed
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If you answered sometimes or never, please rank the following reasons: They're Afraid of the Dental Equipment and/or Have Had Bad Experiences in the Past
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If you answered sometimes or never, please rank the following reasons: We're Too Busy or Distracted to Make the Appointments
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If you answered sometimes or never, please rank the following reasons: The Dentist Lectures Us, or Doesn't Explain Things in a Way We Understand
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If/when I have a limited budget, the following is important to me: Regular Oil Change for Vehicle
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If/when I have a limited budget, the following is important to me: Regular Dental Cleaning
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If/when I have a limited budget, the following is important to me: Regular Health Checkup
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If/when I can easily afford it, the following is important to me: Regular Oil Change for Vehicle
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If/when I can easily afford it, the following is important to me: Regular Dental Cleaning
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
If/when I can easily afford it, the following is important to me: Regular Health Checkup
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my dental health: Nutritious Diet
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my dental health: Brushing Twice Per Day
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my dental health: Flossing
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my dental health: Regular Dental Cleaning/Checkup
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my overall health: Nutritious Diet
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my overall health: A Healthy Mouth
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my overall health: Plenty of Sleep
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my overall health: Regular Exercise
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
The following is important to me for my overall health: Time for Family and/or Activities I Enjoy
strongly disagree
1
2
3
4
5
strongly agree
Clear selection
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