ECDN-IF Dental Services & Awareness Question Title * 1. What county do you currently live in? Benton Cass Chisago Crow Wing Isanti Kanabec Mille Lacs Morrison Pine Sherburne Stearns Todd Wadena Wright Other Other (please specify) Question Title * 2. Are you the parent, guardian or caretaker of a child 0-5 years old? Yes No Question Title * 3. Are you a/an Dental or medical services staff Educational professional Other Specify other profession Question Title * 4. How often do your family members usually visit the dentist? Once a year Every six months Rarely Never Question Title * 5. How did you find your dentist?(Check all that apply) Call number on the back of your insurance card Telephone book Online Referrals; such as a friend/family Information from WIC, Head Start, Childcare Provider or school Medical provider Brochures, posters Other Other (please describe) Question Title * 6. If your family members see the dentist less than twice each year, what are the reasons that stop you from doing so?(Check all that apply) Unsure how often or when my child should have dental health care Too expensive I do not have dental insurance Can not find a dentist who takes my insurance Afraid of going to the dentist (please explain below) Missed an appointment Language barrier Only see the dentist when someone has a toothache Transportation Dentist's hours are inconvenient Too far to a dental facility Too busy Bad previous experiences at the dental office (please explain below) Other N/A Other reason - please describe or elaborate answers from above Question Title * 7. What might be a reason that you would not follow-up with the dentist after he/she has recommended some treatment? Question Title * 8. Is there anything else you would like to tell us about trying to get dental appointments? Next
