The following is a survey to help the New Jersey Academy of Pediatrics understand the dental services provided to and improve access to dental care for children/youth with special health care needs in New Jersey.  All answers will be kept completely confidential, meaning we will not share them with your dentist or anyone else that provides care to you or your child. The survey is completely voluntary, and should any question make you feel uncomfortable, please skip it.  Thank you for your help!

 Questions 1 to 4 refer to the CHILD'S PREVENTIVE DENTAL CARE, such as: frequent dental checkups and dental cleanings to maintain healthy dental health.

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* 1. During the past 12 months, how many times did your child see a dentist for preventive dental care?

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* 2. During the past 12 months, was there any time when your child needed preventive dental care?

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* 3. Did your child receive all the preventive dental care that [he/she] needed?

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