DENTAL CARE SURVEY

VIBE105 FM RESEARCH

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* 1. What is your age?

18 to 24

25 to 40

40 to 55

55 or older

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* 2. Do you presently have a dentist that you visit on a regular basis?

Yes

No

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* 3. How often do you or your family visit the dentist per year?

Monthly

Quarterly

Twice Annually

Annually

Never - can't recall my last visit. (Say cheese! :) )

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* 4. Would you consider changing your dentist?

Yes

No

If yes please explain why.

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* 5. When choosing a dentist what factors are you most likely to consider?

Location

Cost

Customer Care/Service

Specialization (On Site Orthodontist etc.)

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* 6. What is your postal code? (Enter the first 3 digits Ex. L7A or M36)

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* 7. At what email address would you like to be contacted?