2021-2022 Smile Survey (ENGLISH)

Dear Parent/Guardian, please answer these optional questions to help improve dental services. Answers are private.

Question Title

* 1. Since the COVID pandemic started, has it been hard for your child to see a dentist? (Please check all that apply.)

No. My child didn't need to see a dentist. No dental problems

No. My child was able to see the dentist in-person

Yes. I was concerned about safety so didn’t try to see a dentist

Yes. I tried but could not get an appointment for my child

Yes. I was only able to get a teledentistry appointment

Yes. My child’s dental appointment was cancelled for COVID

Yes. My child had to go to the emergency room for dental care

Yes. Too much going on. Dental care was a lower priority

Question Title

* 2. Besides COVID-19 related reasons, was it ever hard for your child to see a dentist? (Please check all that apply.)

Yes. I didn’t have a dentist or know who to go to

Yes. Could not afford dental care

Yes. Did not have dental insurance

Yes. Dentist did not accept my insurance

Yes. Appointment unavailable, inconvenient times

Yes. Could not get to the dental office, transportation issue

Yes. Dentist does not treat young children

Yes. Child was afraid or nervous

Yes. Dental staff does not speak my language

Yes. Don't trust dentists

No. My child was able to see a dentist whenever needed

No reason to go. My child had no dental problems

Question Title

* 3. Has your child ever received any of the following oral health services? (Please check all that apply.)

Advice about a local dentist from a community organization

Dental check-up or screening at the child care

Fluoride varnish application at the child care

Dental screening at the medical doctor (pediatrician) office

Fluoride varnish application at the pediatrician’s office

No. None of the services listed

Question Title

* 4. Has your child ever received any of the following? (Please check all that apply.)

Infant formula from WIC

Free or reduced price meals in child care

CalFresh or EBT

Free Chromebook computer from the school

Water bottle & map to use tap stations across San Francisco

No. None of the resources listed

Question Title

* 5. Does your child have any current dental need? (Please check all that apply.)

Yes, visible cavities or tooth decay

Yes, dental pain

Yes, child care provider says my child should see the dentist

Yes, pediatrician says my child should see the dentist

Yes, friend or family says my child should see the dentist

No. No current tooth decay, pain or need for dental check

Question Title

* 6. Do you currently have any kind of insurance that pays for any of your child's dental care? (Please check all that apply)

No. We do not have any dental insurance

Yes. We have private insurance (Employer-paid or self-paid such as Delta Dental, Aetna, Met life, Blue Cross)

Yes. We have Medi-Cal, Medicaid, or Denti-Cal

We aren’t sure if we have dental insurance

We have another type of government dental insurance such as military or Indian Health Service (IHS)

We have insurance but high copay

Question Title

* 7. How long has it been since your child last visited a dentist or a dental clinic for any reason? (Please check all that apply.)

Within the past 6 months

More than 6 months but less than 1 year ago

More than 1 year, but less than 2 years ago

More than 2 years ago

My child has never visited a dentist or dental clinic

Question Title

* 8. Before kindergarten, where did your child receive child care? (Please check all that apply.)

From family member(s), Babysitter or nanny, Licensed family child care (home based)

Licensed preschool (child care center), Head Start Preschool, SFUSD Preschool

None of the above

Question Title

* 9. When your child was 2 or 3 years old, where did they go to the pediatrician? (Please check all that apply.)

Health Centers: Bayview Child, Castro Mission, Maxine Hall, Mission Neighborhood, NEMS, Ocean Park

Community Clinic: Chinatown Public Health Ctr., Silver Ave Family Health Ctr., Southeast Health Ctr., Potrero Hill Health Ctr.

Hospital or clinic: CPMC, Kaiser, UCSF, ZSFG/SFGH/SF General

Did not have a regular doctor

None of the above

Question Title

* 10. Does your family attend any events hosted by, or receive services from, community organizations? (Please check all that apply.)

APA

Boys & Girls Club

CARECEN

NICOS

JCC

SF Park & Rec

YMCA

None

Other (please specify)

Question Title

* 11. Which of the following describes your child?

African American/Black

Chinese

Latino/a

White

Other Asian, Hawaiian/PI, Native Am., Multi-ethnic