Survey Text

Survey form view entire document:  text  image
These next questions refer to the 2 weeks (outlined on that calendar/beginning Monday (date) and ending Sunday (date)).

9a. During that 2 week period, did anyone in the family miss any time from work or school because of a dental problem or dental visit?

[] Yes
[] No (10)
[] DK (10)

b. Who was this?
Mark "Missed time" box in person's column.

1[] Missed time

c. Anyone else?

[] Yes (Reask 9b and c)
[] No
[] DK