Survey Text

1998
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1998
Survey form view entire document:  text  image

PAJ.020

What brand did you use most often during the past two weeks?
FR: DO NOT READ ANSWER CATEGORIES. CHOOSE ONLY ONE BRAND.
ORWB
(1) ACT, Fluorigard, Kolynos, Listermint, Reach, StanCare (PAJ.040)
(2) Prescription fluoride rinse (END_PAJ)
(3) PLAX (PAJ.040)
(4) Scope, Listerine, Lavoris (PAJ.040)
(5) Other (PAJ.030)
(7) Refused (PAJ.040)
(9) Don't know (PAJ.040)

PAJ.030

FR: SPECIFY THE BRAND NAME OF THE MOUTH WASH OR RINSE
ORWB_1 Name: ______________________

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PCB.060

What brand did {child name} use most often during the past two weeks?

FR: DO NOT READ ANSWER CATEGORIES. CHOOSE ONLY ONE BRAND.
CORWB
(1) ACT, Fluorigard, Kolynos, Listermint, Reach, StanCare (PCB.080)
(2) Prescription fluoride rinse (PCBCCI03)
(3) PLAX (PCB.080)
(4) Scope, Listerine, Lavoris (PCB.080)
(5) Other (PCB.070)
(7) Refused (PCB.080)
(9) Don't know (PCB.080)

PCB.070

FR: SPECIFY THE BRAND NAME OF THE MOUTH WASH OR RINSE
CORWB_1 Name: _____________________________