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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
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?