Uplift, Inc. Dental Hygiene Survey
This form will help Uplift collect information from the general public to help with the formation of a new dental hygiene project.  Dental health is extremely important and we at Uplift want to help the students we serve protect the health of their teeth as much as we possibly can. Poor dental hygiene is linked to poor health and low academic performance.  

Your responses will help inform this effort.  We appreciate your time.  

Feel free to learn more about Uplift, Inc. at http://www.upliftdc.org.

Please take your time and enjoy sharing your responses to the questions.

Thanks and have a great time!


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Tell Us About Yourself!
Age *
Race/Ethnicity *
Gender *
Highest level of education *
What is your family's socioeconomic status? *
Use the image below as a guide.
Do you have any cavities? *
If you could obtain it, would you like a daily record of how you brush? *
How often do you drink soda? *
How often do you eat something sweet? *
How often do you visit the dentist? *
Do you have children in your household? *
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