Dental Anxiety Test

In order to help us assess your Dental Anxiety Level, please answer the following:

1. If you had to go to the dentist tomorrow, how would you feel about it?
A little uneasy
I may break out in a sweat or almost feel physically sick
I would start thinking of ways to cancel the appointment or not show up

2. When you are waiting in the dentist's office for your turn in the chair, how do you feel about it?
A little uneasy
I may break out in a sweat or almost feel physically sick
I start thinking of reasons to avoid the treatment or leave the appointment pre-maturely

3. When you are waiting in the chair while the dentist prepares to give you an injection, how do you feel?
A little uneasy
I may break out in a sweat, become panicky or almost feel physically sick
I am very worried about and afraid for the injection

4. While the dentist is preparing the instruments and the drill, how do you feel?
A little uneasy
I may become panicky and almost feel physically sick
I worry about feeling sharp pain
I can't tolerate the scraping and drilling noises

5. How many negative dental experiences have you had in your life?
Very few
Several
Almost all

6. When did you last see a dentist?
Less than 2 years
Between 2-5 years
More than 5 years

7. Rate your dental health now.
Excellent
Average
Poor

8. Do you feel dentists are efficient, but often seem like they're in a hurry?
Disagree
Partially Agree
Agree

9. Do you feel that dentists do not provide clear explanations?
Disagree
Partially Agree
Agree

10. Do you feel that dentists do not really listen to what you have to say?
Disagree
Partially Agree
Agree

11. Do you question what the dentist has to say about the work that is needed?
No
Sometimes
Usually

12. Do you feel that dentists make light of your fears?
Disagree
Partially Agree
Agree

13. Would you feel embarrassed to interrupt the dental treatment for a moment to rest?
No
Somewhat
Yes

14. Are you aware that Southern Heights Dental Group is specially qualified in Sedation Dentistry for a most comfortable, pain-free dental experience?
No
Yes

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