First name
Last name
Email
Mobile
1.
Have you ever delayed seeing the dentist because of cost?
Please select
Yes
No
2.
What is the longest period of time you have gone between visits to the dentist?
3.
How much was your most recent dentist bill?
4.
Do you have private health insurance?
Please select
Yes
No
5.
Have you had any health consequences from delaying seeing the dentist?
6.
If you have kids, have you ever accessed the Child Dental Benefit Scheme?
Please select
Yes
No
I don't have kids
7.
Would you support the Greens plan to bring dental into Medicare for everyone?
Please select
Yes
No
8.
What impact would bringing dental into Medicare have for you or your family?
9.
Is there anything else you would like to tell us?