Toothpaste Research

Name:
Age: Gender:
Education:
Occupation:

I Agree

Do you use toothpaste while cleaning your teeth?

Yes

No

Who buys your toothpaste?

Yourself

Spouse

Parent

other:_____________________

How many times a day do you use toothpaste?

Once

Twice

Thrice

Other:_____________

Which brand of toothpaste do you use?

Who chooses the brand?

Yourself

Spouse

Parent

Other:_________________

How much toothpaste do you use while cleaning your teeth?

Pea Size

Smear

Half of your toothbrush (bristles) is covered

Over your whole toothbrush (bristles)

Do you wet your toothbrush? If so when?

Yes

No

Before applying toothpaste

After applying toothpaste

Have you ever asked your dentist to recommend a toothpaste brand to you?

Yes

No

Name:
Age: Gender:
Education: Occupation:

Your Dentist

Celebrity Endorsement

Packaging

Taste

Family/Friend

Other:______________________

I allow this survey to be used in research