OraNurse Flavour-free Toothpaste Questionnaire (provided by Dental Direct)

Mouth Care Questionnaire

Thank you for agreeing to take part in our survey. It should take you no longer than 2-3 minutes to complete, but is invaluable for us in the work that we do.

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* 1. Participant Details

First Name

Last Name

Post Code

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* 2. Gender

Male

Female

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* 3. Age

Below 20

21 to 30

31 to 40

41 to 50

51 to 60

61 to 70

71 to 80

Over 81

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* 4. Do you purchase OraNurse for yourself or for someone else?

I purchase OraNurse for myself

I purchase OraNurse for someone else

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* 5. What are the symptoms for which you decided to use OraNurse? (Please select all that apply)

Flavour Hypersensitivity

Dry Mouth

Sore / Burning Mouth

Mouth Ulcers

Stomatitis

Candida

Other (please specify)

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* 6. Do you have any of the following chronic conditions (Please select all that apply)

Behcet’s Disease

Oral Lichen Planus

Cancer

Stroke

Crohn's Disease

Diabetes

Sjogren's Syndrome

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* 7. Are you currently using any other products to alleviate these symptoms, if so which products?

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* 8. Following the use of OraNurse did your condition improve?

Yes

No (If No go to 11)

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* 9. If yes, how long was it before you noticed any improvement?

Immediately

After a couple of minutes

After a couple of hours

After a couple of days

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* 10. Is it your intention to continue to use OraNurse on an on-going basis?

Yes

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* 11. Do you have any other comments or feedback you would like to provide?

Thank you for your participation.