Mobile Dental Hygiene Services

1. Were you aware Dental Hygienists can operate Mobile Dental Hygiene Clinics?

2. Which of the following describes your age group.

You can only select 1 answer.

	18 years of age and under
	19-24 years of age
	25-34 years of age
	35-44 years of age
	45-54 years of age
	55-64 years of age
	65+years of age

3. Do you currently have dental hygiene services available to you within your community?

You can only select 1 answer.

	YES
	NO

4. What community do you currently reside in?

5. Do you currently seek dental hygiene treatment?

You can only select 1 answer.

	YES
	NO

6. What community do you obtain your dental services in.

You can only select 1 answer.

	Drayton Valley, AB
	Leduc, AB
	Wetaskawin, AB
	Edmonton, AB
	Rocky Mountain House, AB
	None of the above

7. Which of the follow best describes how often you seek dental hygiene treatment.

You can only select 1 answer.

	Every 3 months
	Every 6 months
	Every 9 months
	Yearly

8. If dental hygiene services where to be offered in your community via mobile setting, would you be inclined to utilize this service

You can only select 1 answer.

	YES
	NO
	MAYBE

9. If you are interested in being contacted when service becomes available in your community please enter your email address and the community you reside in below. You will only be contacted if/when the mobile service is available in your community.
10. Do you currently have dental benefit coverage? If so what who is the benefit provider (example: Alberta Blue Cross, Greenshield etc.)

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