孩子口腔健康調查 Children Oral Health Survey

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本調查的目的為了解6-17歲的孩子的牙齒及口腔健康而定，收集的資料僅供內部使用。

This survey aims to understand the teeth and oral health condition of 6 to 17 years old children. Data will only be used for internal purpose.

請問你是否有6-12歲的孩子？ Do you have children aged 6 to 17? *

是 Yes

否 No

你孩子的年齡為？（如有多於一位孩子，可再次填寫表單）Age of your child (If you have more than one children, you may refill the form) *

孩子上一次到牙科診所的時間是？Date of last dental visit of your child. *

YYYY

到訪牙科診所的原因是？Reason for last dental visit. *

檢查

洗牙

補牙

箍牙

脫牙

牙科保健

Other:

Required

過去3年，孩子每年平均到訪牙科診所的次數是？In the past 3 years, what is the average number of visiting dental clinic in a year? *

孩子是否有固定的牙醫？Does your child have a family dentist? *

是 Yes

否 No

孩子一年平均洗牙次數 Average time for scaling and cleaning teeth per year *

你滿意孩子的牙齒排列嗎？Are you satisfied with your child's teeth alignment? *

滿意 Yes

有改善空間 Have Rooms For Improvement

你曾否考慮讓孩子箍牙？Have you considered your child to undergo orthodontic treatment? *

是 Yes

否 No

已進行或完成箍牙 Undergoing or Finished Orthodontic Treatment

你會挑選普通科牙醫或矯齒專科醫生為孩子箍牙？Do you prefer gereral dentist or orthodontist to do orthodontic treatment for your child? *

普通科牙醫 General Dentist

矯齒專科醫生 Orthodontist

你會付出多少費用讓孩子箍牙？How much would you willing to pay for your child to undergo orthodontic treatment? *

過住一次牙科檢查及洗牙的費用 The fee of last time scaling and check up

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