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Dental Health & Wellness Survey
This short survey will take approximately 3–5 minutes to complete and help us design better dental wellness initiatives.
ABOUT YOU
*
*
Gender
*
Male
Female
Prefer Not to Say
Other
Age Group
*
Below 25
25 - 34
35 - 44
45-54
55+
Do you currently have any dental insurance or dental benefit?
*
Yes
No
Not Sure
YOUR DENTAL HEALTH
How important do you think oral health is to your overall health??
*
Extremely Important
Very Important
Somewhat Important
Slightly Important
Not Important
How would you rate your oral health?
*
Excellent
Good
Fair
Poor
When was your last dental check-up?
*
Within 6 months
6 - 12 months ago
1 - 2 years ago
More than 2 years ago
Never
Have you experienced any of the following in the last 12 months? (Select all that apply)
Tooth Pain
Tooth Sensitivity
Bad Breath
Bleeding Gums
Cavities
Wisdom tooth pain
Loose teeth
None of the above
Do you find dental treatment expensive?
*
Yes
No
Not Sure
Are you currently delaying any recommended dental treatment?
*
Yes
No
Not Sure
DENTAL WELLNESS
How often do you brush your teeth?
*
Once daily
Twice Daily
More than twice
Occasionally
Do you use any of the following?
*
Dental Floss
Mouthwash
Electric Toothbrush
Tongue Cleaner
None
Would you be interested in
*
Free Dental Check Up
Online Dental Consultation
Oral Health Webinars
Family Dental Benefits
None
INTEREST IN DENTAL BENEFITS
Which Dental Benefits would be most valuable to you?
*
Annual Dental Check Ups
Cashless dental treatment
Braces and Implants Cover
Family Cover
Who would you like covered?
*
Self Only
Self + Spouse
Self + Family
Parents
Entire Family including Parents
If your company offered cashless dental plans, how interested would you be?
*
Extremely Interested
Interested
Maybe
Not Interested
Would you be willing to purchase a voluntary dental plan if offered at a discounted corporate price?
*
Yes
Maybe
No
What Annual cover would be most valuable
*
Less than ₹10,000
₹10,000 - ₹20,000
₹ 20,000 - ₹50,000
₹50,000 - ₹ 75,000
₹75,000+
SMART DENTAL ASSESSMENT
Would you be interested in an AI-powered dental risk self-assessment using smartphone photos?
*
Yes
Maybe
No
Would you like a personalized dental health report?
*
Yes
Maybe
No
Submit
