2021-2022 Smile Survey (ENGLISH)
Dear Parent/Guardian, please answer these optional questions to help improve dental services. Answers are private.
OK
1.
Since the COVID pandemic started, has it been hard for your child to see a dentist? (Please check all that apply.)
No. My child didn't need to see a dentist. No dental problems
No. My child was able to see the dentist in-person
Yes. I was concerned about safety so didn’t try to see a dentist
Yes. I tried but could not get an appointment for my child
Yes. I was only able to get a teledentistry appointment
Yes. My child’s dental appointment was cancelled for COVID
Yes. My child had to go to the emergency room for dental care
Yes. Too much going on. Dental care was a lower priority
2.
Besides COVID-19 related reasons, was it ever hard for your child to see a dentist? (Please check all that apply.)
Yes. I didn’t have a dentist or know who to go to
Yes. Could not afford dental care
Yes. Did not have dental insurance
Yes. Dentist did not accept my insurance
Yes. Appointment unavailable, inconvenient times
Yes. Could not get to the dental office, transportation issue
Yes. Dentist does not treat young children
Yes. Child was afraid or nervous
Yes. Dental staff does not speak my language
Yes. Don't trust dentists
No. My child was able to see a dentist whenever needed
No reason to go. My child had no dental problems
3.
Has your child ever received any of the following oral health services? (Please check all that apply.)
Advice about a local dentist from a community organization
Dental check-up or screening at the child care
Fluoride varnish application at the child care
Dental screening at the medical doctor (pediatrician) office
Fluoride varnish application at the pediatrician’s office
No. None of the services listed
4.
Has your child ever received any of the following? (Please check all that apply.)
Infant formula from WIC
Free or reduced price meals in child care
CalFresh or EBT
Free Chromebook computer from the school
Water bottle & map to use tap stations across San Francisco
No. None of the resources listed
5.
Does your child have any current dental need? (Please check all that apply.)
Yes, visible cavities or tooth decay
Yes, dental pain
Yes, child care provider says my child should see the dentist
Yes, pediatrician says my child should see the dentist
Yes, friend or family says my child should see the dentist
No. No current tooth decay, pain or need for dental check
6.
Do you currently have any kind of insurance that pays for any of your child's dental care? (Please check all that apply)
No. We do not have any dental insurance
Yes. We have private insurance (Employer-paid or self-paid such as Delta Dental, Aetna, Met life, Blue Cross)
Yes. We have Medi-Cal, Medicaid, or Denti-Cal
We aren’t sure if we have dental insurance
We have another type of government dental insurance such as military or Indian Health Service (IHS)
We have insurance but high copay
7.
How long has it been since your child last visited a dentist or a dental clinic for any reason? (Please check all that apply.)
Within the past 6 months
More than 6 months but less than 1 year ago
More than 1 year, but less than 2 years ago
More than 2 years ago
My child has never visited a dentist or dental clinic
8.
Before kindergarten, where did your child receive child care? (Please check all that apply.)
From family member(s), Babysitter or nanny, Licensed family child care (home based)
Licensed preschool (child care center), Head Start Preschool, SFUSD Preschool
None of the above
9.
When your child was 2 or 3 years old, where did they go to the pediatrician? (Please check all that apply.)
Health Centers: Bayview Child, Castro Mission, Maxine Hall, Mission Neighborhood, NEMS, Ocean Park
Community Clinic: Chinatown Public Health Ctr., Silver Ave Family Health Ctr., Southeast Health Ctr., Potrero Hill Health Ctr.
Hospital or clinic: CPMC, Kaiser, UCSF, ZSFG/SFGH/SF General
Did not have a regular doctor
None of the above
10.
Does your family attend any events hosted by, or receive services from, community organizations? (Please check all that apply.)
APA
Boys & Girls Club
CARECEN
NICOS
JCC
SF Park & Rec
YMCA
None
Other (please specify)
11.
Which of the following describes your child?
African American/Black
Chinese
Latino/a
White
Other Asian, Hawaiian/PI, Native Am., Multi-ethnic
Current Progress,
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