"Achieving Oral Health Equity in Tampa Bay Initiative" 

The data from this survey will be used to identify opportunities to educate and raise awareness
for the importance of oral health as part of overall health and wellness.

Please, mark the circle or fill in the blank for the best possible answer to each question.
Return this survey when complete and receive your gift. Thank You!

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* 1. What County does this organization serve?

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* 2. What is the name of your organization?

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* 3. What population does your organization primarily serve?

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* 4. What age demographic does your organization primarily serve? (Please, choose  ALL that apply)

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* 5. Which of the following types of insurance does your organization accept? (Please, choose  ALL that apply)

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* 6. How would rank the importance of oral health?

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* 7. Choose your level of agreement to each question

  Agree Somewhat Agree Disagree Somewhat Disagree Neither Agree nor Disagree Don't Know
Poor oral health can impact various overall health concerns? (I.e. Diabetes)
A person is not healthy if they are in poor oral health.
Advancing interprofessional relationships and coordinated care will ensure that all people have the opportunity to attain their full potential and are not disadvantaged by socially determined circumstances.
My organization has a client referral process with local dental service providers?
My organization distributes educational dental health information to clients
The population my organization serves would benefit from expanded dental health services
Oral health education should be incorporated into the primary education system
Achieving oral health equity is a matter of social justice
Expanding adult dental Medicaid benefits who help address the gap in adults seeking dental services

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* 8. Did you know there is a school based dental sealant program available to children in your community?

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* 9. How would you describe the communication between dental professionals and their patients? (I.e. answering questions & explaining what they need to know)

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* 10. Does your organization include dental health screenings during hosted health related events?

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* 11. In your opinion, which of following are leading causes for the oral health disparities that exist in Tampa Bay? (Please, choose ALL that apply)

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* 12. In your opinion, which of the following would cause a patient to delay or avoid a dental appointment? (Please, choose ALL that apply)

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* 13. In your opinion, which of the following are barriers to patients accessing dental care? (Please, choose ALL that apply)

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* 14. If you would like to share additional comments about your oral health beliefs and perceptions, dental experiences or barriers in access to care please print them here.

Thank you very much for completing this survey.
Please, return the completed survey and receive your gift.

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