Tobacco & Oral Health Questions

Question Title

* 1. How old are you?

13 - 19

20 - 29

30 - 39

40 - 49

50 - 59

60 -69

70 - 79

Question Title

* 2. What's your gender?

Male

Female

Question Title

* 3. If you are a smoker at what age did you start smoking?

9 - 19

20 - 39

40 - 59

60 - 79

Question Title

* 4. Do you have a respiratory problems?

Yes

Question Title

* 5. How often do you get dental appointment?

Yearly

Every 6 months

I go only when my teeth hurt

Question Title

* 6. Does your teeth hurt when you smoke?

Yes

N/A

Question Title

* 7. Do you have swollen gums?

Yes

Question Title

* 8. Does your gums bleed when you brush your teeth?

Yes

Question Title

* 9. Are you interested in enrolling in tobacco cessation program or receive information on Vaping?

Yes

Tobacco & Oral Health Questions

Question Title

* 1. How old are you?

Question Title

* 2. What's your gender?

Question Title

* 3. If you are a smoker at what age did you start smoking?

Question Title

* 4. Do you have a respiratory problems?

Question Title

* 5. How often do you get dental appointment?

Question Title

* 6. Does your teeth hurt when you smoke?

Question Title

* 7. Do you have swollen gums?

Question Title

* 8. Does your gums bleed when you brush your teeth?

Question Title

* 9. Are you interested in enrolling in tobacco cessation program or receive information on Vaping?

Question Title

* 10. If yes please contact us at 1-318-450-4888