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COHI Better Oral Health Survey (English)

This survey will take approximately 5 minutes to complete.


Survey Purpose:  To understand barriers to accessing and obtaining quality dental care in Connecticut

COHI Mission: To strengthen and safeguard access to quality, affordable oral health services for all Connecticut residents.
1.Where are you taking this survey?
2.What town or city do you live in?
3.What is your age?
4.What is the highest degree or level of school you have completed?
5.Do you identify as? (Check all that apply)
6.Are you currently working? (Check one that best applies to you)
7.What is your annual household income?
8.Which category best describes you? (Check all that apply)
9.How many people live in your household, including yourself?
10.How many children, 21 and under, are currently living with you?
11.What type of insurance do you currently have?
12.Where do you usually go for dental care? (Choose only one)
13.If you answered "private dentist office" where do you go? (If not, SKIP this question)
14.When was the last time you visited a dentist?
15.The last time you saw a dentist, why did you go? (Check what applies to you)
16.How satisfied were you with your last dental visit?
17.How would you rate your oral health?
18.What makes it difficult for you to obtain the dental care that you need? (Check all that apply)
19.How many times a day do you floss your teeth?
20.How often do you brush your teeth?
21.Do you have any pain or bleeding in the gums and/or mouth?
Current Progress,
0 of 21 answered