One and Two Year Old Child Survey
As the primary care giver of this child, how would you rate your oral health?
As the primary care giver of this child, how would you rate your knowledge of oral health?
How many teeth does your child have at this time?
Does your child have any dental or oral problems?
If so, what are they?
Are you happy with the appearance of your child's teeth?
If not, what is it that concerns you?
Do you clean your child's teeth?
What do you use to clean them?
Does your child currently use:
Does your child currently:
Suck their Thumb
Use a Pacifier
Where does the water you drink and cook with come from?
May we take a photo of your child's first visit and post it on our Facebook Page?
What other questions or concerns would you like to have addressed at this appointment?
Please verify that you are human
Should be Empty: