Oral Health Questionnaire
Hi! Thanks for taking the time to answer a few questions. This will help us learn about people's oral health behaviors, preferences, and ways to improve the delivery of dental care

Complete the questionnaire to enter your chances to win a $100 Amazon gift card (up to 5 gift cards available to win!).

Entrants will be included in the draw for prizes that will happen after the completion of this study. You will only be contacted if you win one of the raffle prizes.
Sign in to Google to save your progress. Learn more
Contact and Demographic Information
What e-mail address should we send the gift card to? *
If you win of course!
Where are you located? *
Please include state/province and country (e.g. Toronto, Ontario, Canada)
Input preferred name *
We’d love to address you correctly if you win!
What is your age group? *
How do you identify? *
Do you have dental insurance?
Clear selection
Your experience with dental care, the dentist, and your oral health
We want to better understand the overall patient experience and make dental care better for all

On a scale of 1-10, how would you self-rate your oral health today? *
Needs urgent care/help
Perfect - no issues
When was your last dental appointment? *
What was the reason for your last dental appointment?
Clear selection
Do you have a dentist that you routinely visit? Are you a patient at a dental office? *
How often do you visit the dentist in a year? *
Rank the importance of the following factors when finding/choosing a dentist (1 being the most important factor) *
1
2
3
4
5
6
7
Proximity to my home or work address
Google reviews and rating
Use of technology / modernization of dental office (digital forms, new equipment, etc.)
Someone I know/trust is a patient there (referred by friend/family member)
Personality of dentist / dental team and staff
Transparency, honesty, and authenticity during interactions
Pre- and post-appointment experience (online booking, take-home patient education and information, etc.)
Do you see yourself using an app to manage your oral health? *
When thinking about your overall health? Where do you consider/rank your oral health in terms of importance? *
Forgot oral health is part of overall health
The most important part of my body
What feature, if any, would make you want to use an app to manage your oral health journey most? *
Would you rather book your next dental appointment online (like a restaurant or hotel reservation) or through a phone call/e-mail?
Clear selection
What would you prefer as a new patient at a dental office? *
Which of the following parts of your experience as a dental patient do you dislike the most? *
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