Dental Clinic Question Title * 1. Which age group do you belong to? w 0 Below 20 21-30 31-40 41-60 61-80 and above Question Title * 2. Are there children in your home? w 0 Yes No Question Title * 3. If yes to number 2, what ages? w 0 0-3 4-5 6-12 12-21 Question Title * 4. Have your or your children been to the dentist in the last 3 years? w 0 Yes No Question Title * 5. If no, please indicate the reason w 0 Can't afford deductible or co-pays No dental insurance Lack of transportation Fear of dentist Bad experience with a dentist Oral health is not important Question Title * 6. Would you utilize a dental clinic if offered by the Scotland County Health Department w 0 yes no Question Title * 7. Do you have any other comments, questions, or concerns? w 0 Done