Please complete the “Vital Elements of the Ideal Hygiene Visit” survey. Each survey question is an activity performed in an "average" continuing care hygiene visit (not necessarily a periodontal appointment), and cannot be skipped.

If you do not perform all the procedures at every continuing care visit, please record the amount of time it takes when you do perform the activity.

Plus, you may not perform some of the activities (i.e. blood pressure). Please write in "0 mins."

Tell us how long it does take you to complete each activity (when you do perform it). And again, type in "0 mins" if you do not currently incorporate such activity in your appointment.

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1. What is your primary occupation on the date of completing this survey?
 (Required.)

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2. Greet/seat and re-establish relationship with patient. Estimated time is: (Required.)

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3. Review medical/dental/behavioral history. Estimated time is: (Required.)

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4. Take bitewings. Estimated time is: (Required.)

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5. Take full-mouth radiographs. Estimated time is: (Required.)

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6. Periodontal exam/assessment. Estimated time is: (Required.)

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7. Scaling. Estimated time is: (Required.)

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8. Patient education. Estimated time is: (Required.)

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9. Polishing. Estimated time is: (Required.)

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10. Doctor periodic exam. Estimated time is:

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11. Restorative assessment. Estimated time is: (Required.)

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12. Use of intraoral camera. Estimated time is: (Required.)

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13. Fluoride varnish/treatment (as needed). Estimated time is: (Required.)

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14. Patient records/charting. Estimated time is: (Required.)

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15. Blood pressure. Estimated time is: (Required.)

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16. Genetic test for susceptibility to oral diseases. Estimated time is: (Required.)

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17. Caries susceptibility tests. Estimated time is: (Required.)

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18. Oral cancer screening. Estimated time is: (Required.)

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19. Nutritional counseling. Estimated time is: (Required.)

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20. Tobacco counseling. Estimated time is: (Required.)

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21. Post-appointment break down and new set-up. Estimated time is: (Required.)

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22. Unspecified service/procedure. What did we miss? Estimated time is:

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23. What service would you like to begin incorporating into your hygiene appointment? Estimated time is:

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24. In what ZIP code is your office(s) located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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