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Overall Health
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Does your health keep you from doing any of you daily activities?
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Do you have any movement difficulties?
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Do you have any disease that needs monitoring?
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Oral Health
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Do you consider it important to take care of your mouth?
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Do you believe that mouth diseases can be avoided?
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Do you consider yourself responsible for your oral health?
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Do you consider it important to have all the teeth in your mouth?
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Infrastructure
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Do you have a bathroom in your house?
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Do you have electric power in your house?
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Do you have running water in your house?
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Do you have sewage collection at your house?
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Healthcare Services
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Are you familiar with the public primary care unit where you can visit?
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Do you use a public primary care unit?
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Are you accompanied by an oral health team?
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Do you see the dentist without paying?
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