3. What are the reasons -- has (not visited the dentist in over 12 months/never gone to the dentist)?
Do not read categories. Circle all that apply.
01[] Afraid
02[] Nervous
03[] Needles
04[] Cost
05[] Don't know dentist
06[] Dentist too far
07[] Can't get there
08[] No problems
09[] No teeth
10[] Not important
11[] Didn't think of it
88[] Other (Specify) ____
99[] Don't know