Dental Survey Name First Last Have you visited the dentist in the last year?YesNoAre you in a full upper and lower denture?YesNoNeitherAre your dentures comfortable?YesNoN/AIs your dentures older than 3 years?YesNoN/ADo you have any broken teeth?YesNoDo you have any dental pain?YesNoDo you have any difficulty eating the foods you want?YesNoWould you visit a dentist if they were located here at Twin Creeks?YesNoAre you allergic to dogs?YesNoDo you have any dental coverage?YesNo
