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Florida New Member Survey

Member Information

Your DentaQuest Member ID number is the 9- or 10-digit number on the front of your card
Your dental plan*

New Member Survey

Do you have tooth pain or a dental problem right now?*
Have you been to the Emergency Room for a dental problem in the past 12 months?*
Was your last visit to the dentist more than 12 months ago?*
Do you brush your teeth less than twice a day?*
Do you have a special need that makes it hard to see the dentist?*
If yes, which one? (Select all that apply)
Are you pregnant?*
Do you have a health problem or illness that makes it hard for you to see the dentist?*
If yes, which one? (Select all that apply)
Do you have any other type of problem that makes it hard for you to see the dentist? (For example, "I don't have a way to get to the dentist.")*
Preventistry Pulse

PREVENTISTRY PULSE

The newsletter designed for anyone who wants to improve oral health for themselves, their families, customers or communities.