Do you need an Oral Health Coach?

1

How often do you brush your teeth?* This field is required.Be honest

2x a day

1x a day

When I remember

1-3x a week

Never

More than 2x a day

3

What do you struggle with in your oral care routine?

Don’t have time

Don’t spend enough time/rush through

Don’t know what products to use

Forget to repurchase when I run out

I don’t know much about oral care

Can’t form a good habit

4

Do you have a Dental Fear or Dental Anxiety?

YESNO

5

Do you want to raise your Dental IQ?

YESNO

6

Have you ever been told you need a “deep cleaning”?

YESNO

7

Have you ever been told you have gingivitis?

YESNO

8

Have you ever been told you have periodontal disease?

YESNO

9

Name* This field is required.

First Name

Last Name

10

Email* This field is required.

example@example.com