CONSENT FORM

I — hereby give my permission to Dr Rachita Mehlawat to allow me to respond to a questionnaire and quote my responses in a scholarly research paper. I understand that her work is for academic purposes. I also understand that I also waive any claim for copyright to this material should the researchers ever publish it in a scholarly journal or in electronic format online. I understand that the research title is "Effect of educational training on knowledge, attitude and practice of pediatricians about infant oral health and early childhood caries in children including with special healthcare needs in Dwarka sub-city". I also understand that the researcher Dr Rachita Mehlawat will maintain my anonymity with regard to my responses to questionnaire items. I hereby give my permission in the form of my signatures below.

Researcher : Dr. Rachita Mehlawat
Contact No : +91-9599052809
Email : drrachitamehlawat@gmail.com

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When does the first tooth erupt in oral cavity ? *

When should oral cleaning be started in infants ? *

Can formula milk cause dental caries ?*

If a child with fever and facial swelling comes to you which seems secondary to milk tooth decay, what would you advise the parents? *

Are yellowish/whitish/brownish patches on teeth any cause of concern ? *

Which of the following is true about Zinc / Iron / Medication syrups and multivitamin gummies ? *

What is your self assessment about your knowledge related to dental health problems ? *

Which among the following is more important cause of dental caries ? *

What according to you is the appropriate time/age for first dental visit of the child ? *

Do you routinely examine your patients for dental decay ? *

Do you educate parents about prevention of dental decay ? *

If a parent asks you about a dental problem of their child, whom do you refer them to ?*

How often parents ask your opinion about child's dental problems? *

Do you feel the need for education program about children's dental and oral health ? *

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