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* 1. Contact Info:

* 2. Gender:

* 3. Date of Birth (Ex. 08/25/1987)

* 4. Industry & Title:

* 5. What best describes your marital status?

* 6. What best describes your annual household income?

* 7. What best describes your ethnicity?

* 8. What is your current employment status?

* 9. Which, if any, of the following types of products do you personally use on a regular basis?

* 10. Which of the following best describes your role in deciding what brand and type of oral care products to purchase and use?

* 11. Approximately, how many times a day do you brush your teeth with toothpaste?

* 12. What are all the brands of toothpaste you, yourself, have used in the past 6 months, whether you use them all of the time, some of the time or occasionally?

* 13. Which, if any, of the following brands of toothpaste would you NOT consider using in the future?

* 14. Which of the following types of dental work or devices, if any, do you currently have?

* 15. About how often do you visit a dentist for a routine check-up?

* 16. Do you have any extreme dental or gum issues that require the on-going care of a dentist or gum specialist, e.g., monthly visits?

* 17. Please rate how concerned you are about the following conditions:

  Extremely Concerned Very Concerned Somewhat Concerned Not very Concerned Not at all Concerned
Teeth sensitivity to hot or cold
Cavities
Weakening of enamel or erosion of enamel
Tooth discoloration
Receding gums/ gum recession

* 18. What is the make and model of your current mobile phone?

* 19. Where did you hear about this study?

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