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Portage Zhang Senior Center & KVCC Dental Program

Greetings!

In preparation for an upcoming presentation by KVCC Dental Hygienists, they've asked for your feedback to tailor their presentation better. Please complete the following survey upon your convenience.

**Please only complete one survey per person.
1.How often do you brush your teeth?(Required.)
2.How often do you use mouthwash?(Required.)
3.Does your current toothpaste have fluoride in it?(Required.)
4.Do you use an electric toothbrush or a manual toothbrush?(Required.)
5.Does food or floss catch between your teeth?(Required.)
6.Do you have any oral appliances (Such as dentures, partials, retainers, bite splints, veneers, etc.)(Required.)
7.Do you struggle with bad breath?(Required.)
8.Is your mouth often dry?(Required.)
9.Do you have arthritis or other dexterity issues?
10.Do you smoke, chew or vape any tobacco products?
11.Are you interested in learning about whitening options?
12.Have you ever been diagnosed with periodontal or gum disease?(Required.)
13.Has anyone in your family ever been diagnosed with periodontal or gum disease?(Required.)
14.Does limited financial resources prevent you from seeking preventative or other dental services?(Required.)
15.Other dental topics you'd like to learn more about?
16.Your Name (Optional):