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Dental Care Experience Survey

For patients with disabilities, their family members and caregivers

The Viscardi Center is working with Propensity, a strategic communications firm supporting a nonprofit university dental center, to help raise awareness and improve access to specialized dental care. To assist us in this important effort, we invite you to complete this brief 5- to 10-minute survey. Your input will help improve dental care for you, your family, and other members of our community. If possible, please complete the survey by Thursday, July 30.
1.Which best describes you?
2.Does the person with a disability currently live in any of the following settings? (Select one)
3.Age(s) of the person(s) receiving care (Select all that apply)
4.Type of disability for the person(s) receiving care (Select all that apply):
5.How often does the person(s) receive dental care?
6.Where does the person(s) primarily receive dental care?
7.How easy or difficult is it to get the dental care you/they need?
8.What challenges have you experienced when seeking dental care?
(Select all that apply)
9.What would make your dental visits easier or better?
10.In many areas, families report long wait times for appointments or difficulty finding appropriate care. If there were a dental clinic designed for people with disabilities (trained staff, supportive environment), how likely would you be to use it?
11.How far would you be willing to travel for the right care?
12.Where do you usually go for dental health information and support? (Select all that apply)
13.Would you like to receive information about disability-friendly dental care?
14.If yes, how would you prefer to receive this information? (Select all that apply)
15.Before today, were you aware of dental providers who specialize in care for people with disabilities?
16.Have you heard of the Oral Health Center for People with Disabilities (OHCPD) at NYU Dentistry, located in Manhattan, New York City?
17.If yes, how did you hear about it?
Thank you for taking part in this survey!