CANKER SORE SURVEY

Your E-mail Address:

Gender: Male Female

Age: Under 16 16-24 25-35 35-45 45-55 Over 55

1. How Did You Find The Canker Sore Relief Center?:

2. On average how painful are your canker sores ?

Extremely painful Very painful Mildy painful Not painful

3. How much do canker sores affect your lifestyle ?

Greatly affect my lifestyle Mildly affect with my lifestyle Minimally affect my lifestyle (mild nuisance) Do not affect my lifestyle

4. Where do you usually find general information about canker sores ?

Visit to the drug store or supermarket
Newspapers / Magazines
Television
Dentists or Physician
Internet
Friend or Word of Mouth
My Own Research
Other (Please list)

5. What is the primary way you find out about specific canker sore medications ?

Visit to the drug store or supermarket
Newspapers / Magazines
Dentists or Physician
Internet
Friend or Word of Mouth
Other (Please list)

6. What is the most effective canker sore treatment which you use ?

7. How knowledgeable is your dentist or doctor about canker sores ?

Very Knowledgeable
Somewhat Knowledgeable
Knows a Little Bit
Is Totally Clueless

8. If there was a free service which periodically e-mailed you information on canker sore treatment products would you sign up ?

Yes
No

9. What oral health care products do you use on a consistent basis ?
(Please check all that apply)

Electronic Toothbrush
Tooth Floss
Water Pick
Mouthwash
Tongue Scaper
Dental Chewing Gum

9. What oral health care products do you use on a consistent basis ?
(Please check all that apply)

Electronic Toothbrush
Tooth Floss
Water Pick
Mouthwash
Tongue Scaper
Dental Chewing Gum

10. Do you have any suggestions concerning improving or adding additions to the Canker Sore Relief Center ?