Q01
메시지
모든 템플릿
Dental Health History and Care Habits Survey
Captures a respondent's dental visit history, oral hygiene habits, past procedures, and comfort level with dental care, for use by clinics, insurers, or researchers studying access and prevention. An AI follow-up interview digs into the real reasons behind dental anxiety or delayed care, going beyond a checkbox answer.
샘플 질문
템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.
질문 13개 · 약 7분
Q02
객관식필수
When was your last dental check-up or cleaning?
- Within the last 6 months
- 6-12 months ago
- 1-2 years ago
- More than 2 years ago
- I've never had one
Q03
객관식필수
What was the main reason for your most recent dental visit?
- Routine cleaning or check-up
- Pain or discomfort
- A cosmetic concern
- Emergency (injury or broken tooth)
- Follow-up on prior treatment
Q04
매트릭스필수
In a typical week, how often do you do each of the following?
3개 행 × 5개 열
- Brushing your teeth
- Flossing
- Using mouthwash
열: Never · A few times a week · Once a day · Twice a day · More than twice a day
Q05
의견 척도필수
How would you rate the current health of your teeth and gums?
척도: 1 – 10
최소:Poor최대:Excellent
Q06
객관식
Which of the following dental procedures have you had in the past? Select all that apply.
- Filling
- Root canal
- Tooth extraction
- Crown or bridge
- Braces or other orthodontics
- Dental implant
- Professional teeth whitening
Q07
의견 척도필수
How anxious or nervous do you feel about visiting the dentist?
척도: 1 – 7
최소:Not anxious at all최대:Extremely anxious
Q08
객관식필수
In the last 12 months, has cost ever kept you from getting dental care you needed?
- Yes
- No
- Not sure
Q09
객관식
Do you currently have dental insurance or a dental benefit plan?
- Yes
- No
- Not sure
- Prefer not to say
Q10
AI 인터뷰
Explore the specific source of the respondent's dental anxiety or hesitation—whether it stems from pain, a past bad experience, sounds or smells, cost, or loss of control—and how that anxiety has actually changed their behavior, such as delaying a visit or avoiding a specific procedure. If they reported low anxiety, ask what makes their visits comfortable so we can identify best practices to share with providers. If they flagged cost as a barrier, probe what specific expense or insurance gap caused them to skip care and what it would take for them to return.
Q11
객관식
Which age range do you fall into?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65 or older
- Prefer not to say
Q12
객관식
What is your gender?
- Woman
- Man
- Non-binary
- Prefer not to say
Q13
메시지
That's everything, thank you! Your responses will be combined with others to help improve dental care access and reduce the barriers that keep people from getting the treatment they need.
포함된 기능
AI 후속 질문
정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.
주의력 확인 장치
성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.
AI가 작성한 문안
문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.
자동 리포트
응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.
다른 서비스와 비교
다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.
이 템플릿을 선택하는 이유
- Goes beyond checkbox history questions with an AI follow-up interview that explores the real reasons behind dental anxiety or delayed care
- Combines structured questions (visit timing, procedures had, weekly hygiene habits via a matrix question, insurance and cost-barrier questions) with open-ended AI probing in one flow
- Captures self-rated oral health and anxiety on opinion scales, then lets the AI interview dig into the 'why' behind those ratings rather than stopping at a number
- Includes demographic questions (age range, gender) so clinics, insurers, or researchers can segment access and prevention patterns
SurveySparrow
Dental Health History QuestionnaireA ready-to-field dental health history template covering visit history and habits, built on SurveySparrow's conversational-style form format. It's designed for quick self-serve deployment by dental practices rather than deep behavioral research. No indication of adaptive follow-up questioning beyond its fixed script.
잘하는 점
- Fielding-ready template, no build required
- Conversational chat-style UI that can feel more personal than a standard form
- Likely easy to embed on a dental practice website or patient portal
아쉬운 점
- Static question set with no adaptive AI follow-up to probe reasons behind anxiety or delayed care
- No automated per-response quality scoring
- No voice AI interview option
Jotform
Dental Health History Form TemplateA standard fillable form template for capturing dental history, likely aimed at intake/onboarding at a dental office rather than research. Strong for form-building flexibility and integrations but is a static questionnaire, not an interview instrument. Good for paperwork replacement, less suited to studying the 'why' behind patient behavior.
잘하는 점
- Highly customizable form builder with drag-and-drop fields
- Broad integration ecosystem (payments, e-signature, storage)
- Familiar, easy-to-complete form format for patients
아쉬운 점
- No adaptive AI follow-up interview or voice interview option
- No automated quality scoring of responses
- Not designed to surface underlying reasons for anxiety or delayed care, only checkbox/text answers
Typeform
Dental Health History Form TemplateA polished, one-question-at-a-time dental history template with Typeform's signature conversational design. It's well-suited to patient intake and general data collection but functions as a fixed-path form, not a research interview tool. No mention of AI-driven probing or scoring of response quality.
잘하는 점
- Clean, engaging one-question-at-a-time UI known for high completion rates
- Easy to theme/brand for a clinic or organization
- Simple logic-based branching between fixed questions
아쉬운 점
- No AI follow-up interview to explore root causes of anxiety or care avoidance
- No voice AI interview option
- No automated per-response quality scoring or auto-generated analytical reports
설문을 공개할 준비가 되셨나요?
이 템플릿을 편집기에서 열어 보세요. 첫 응답자가 보기 전에 모든 부분을 원하는 대로 바꿀 수 있습니다.