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* 1. That you for participating in this survey about fees charged to dental patients. May we start by asking in what state you practice primarily as a dental hygienist?

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* 2. Have you noticed that dental facilities where you practice as a dental hygienist have started charging additional fees for ancillary services?

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* 3. Does a dental office where you practice charge additional fees above and beyond standard fees for any of the following?

  Yes No Unsure
Cleaning of implant-restored teeth
Nitrous oxide/anesthetics
Filling out insurance forms
Home care aids
Missed appointment charges
Patient education
Caries detection technologies

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* 4. Does your dental facility give away free toothbrushes, floss, and/or toothpaste after a recare appointment?

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* 5. What specific products does your office provide to patients as a courtesy (no cost) after appointments?

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* 6. What services do you feel like your dental facility provides for "free" to dental patients?

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* 7. What do you think the reasons are for extra charges?

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* 8. Overall, how would you rate your comfort level for ALL fees assessed to patients?

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* 9. Would you like to elaborate on your answer to the last question, or offer a comment on dental fees in general? Thank you for taking the time to complete this survey.

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