1971 |
For each dental visit, ask:
9a. What did -- have done (the last time, the time before, etc.)? (Mark all that apply for each visit)
[Columns 1-3 for different people omitted here]
[] Exam. (X-ray)
[] Fillings
[] Extractions or other surgery
[] Straightening (Orthodontia)
[] Treatment for gums
[] Denture work
[] Other (Describe) ________
b. Anything else?
[] Exam. (X-ray)
[] Fillings
[] Extractions or other surgery
[] Straightening (Orthodontia)
[] Treatment for gums
[] Denture work
[] Other (Describe) ________