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Dental Needs Survey
Please answer the following questions to help Tri-Area Community Health determine the need for dental services in your community.
1.
Do you or anyone in your household have a dentist that they see on a regular basis?
Yes
No
2.
Have you ever had difficulty obtaining a dental appointment?
Yes
No
3.
Do you have dental insurance? If so, what type?
Yes
No
Insurance type?
4.
Are you a current Sliding Scale patient at Tri-Area Community Health?
Yes
No
5.
If Tri-Area Community Health offered dental services, would you use them?
Yes
No
6.
Are you aware that Tri-Area Community Health offers Transportation Services?
Yes
No
7.
Do you use our Transportation Services?
Yes
No
8.
If you drive, how far would you be willing to travel for dental services?
10 miles
25 miles
50 miles
9.
How far would you be willing to travel for dental services using Tri-Area Community Health Transportation Services?
10 miles
25 miles
50 miles
10.
What Tri-Area Community Health location do you currently use?
Ferrum
Floyd
Troutdale
Laurel Fork
