Oral Health Survey Pehea kou waha?(How's your mouth?) Question Title * 1. Age: What is your age on Aug 1, 2018? For babies less than 1 year old write 0 as the age. Age on August 1, 2018 OK Question Title * 2. Sex: What is your sex? (check one box below) Male Female Prefer not to answer OK Question Title * 3. Race: Are you Native Hawaiian? (check one box below) Yes No OK Question Title * 4. Zip Code (write below) OK Question Title * 5. What year was your last dental visit? (write below) OK Question Title * 6. How many times a day do you brush your teeth? (write in below) OK Question Title * 7. How many times a day do you floss your teeth? (write in below) OK Question Title * 8. Do you use mouthwash? (check one below) Yes No OK Question Title * 9. Do you have any of the following? (Check all that apply) Missing Teeth Bridge(s) Dentures Implants Partial Dentures None Crowns/Veneers Other (please specify) OK Question Title * 10. Please rate your overall Oral Health on a scaled from 1 (worst) to 5 (excellent). 1 (Worst) 2 3 4 5 (Excellent) 1 (Worst) 2 3 4 5 (Excellent) OK Question Title * 11. Can you describe what would help you achieve a higher level for your oral health, or if already excellent, how do you maintain that level. (Please provide comments below) OK MAHALO NUI FOR PARTICIPATING!