Hi

This is the survey I wanted to do for a long time. I will collect all the data that you submit and we can use it for research. You can suggest which field should I add that I forgot. Please fill out the survey and it will be send to my email and later I will publish the results. We have to send these data to some scientists that might help us.

Name:
Age:
Sex: Male Female
Intensity of bad breath 1 - 10 (10 is the strongest) 1 2 3 4 5 6 7 8 9 10
How does your bad breath smell like
Are you non vegetarian vegetarian vegan raw foodist
Do you have Post nasal drip yes no I do not know
Do you have allergies yes no I do not know
If yes what are they
Do you have coated tongue yes no
Do you have tonsils yes no
Do you have tonsils stone yes no
What is the condition of your teeth healthy not healthy somewhere in the middle
Do you have metal (amalgam - mercury) fillings in your mouth: If yes how many
Do you have root canals in teeth, if yes how many
If you floss between the teeth, does the floss smell bad yes no
Do you think a psychological trauma in the past has caused bad breath. Describe precisely
Do you have any other health problems: please describe
Do you have acid reflux yes no
Do you have chest pains yes no
Do you have a lump in your throat yes no
How much water do you drink per day (glasses)
Do you suffer psychologically because of it
How do your parents or your relatives react
How do people react on your bad breath
Do you have a partner, wife, husband... yes no
How long do you have bad breath years
Do you suffer because of it yes no
Do you snore yes no
What is your blood type type A B AB 0
Is your bad breath getting worse yes no I do not know
Where do you thing the problem lies in your body
Has something that you tried helped in reducing bad breath
Do you use any mouthwash or any other products, please tell us which
Do you have a job
How do you feel at your job, do coworkers react badly
How did Bad Breath influence your life
Have you find out something that other should hear about Bd Breath
Tell us other facts of your bad breath that we forgot to ask you