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?
2. When you are waiting in the dentist’s office for your turn in the chair, how do you feel about it?
3. When you are waiting in the chair while the dentist prepares to give you an injection, how do you feel?
4. While the dentist is preparing the instruments and the drill, how do you feel?
5. How many negative dental experiences have you had in your life?
6. When did you last see a dentist?
7. Rate your dental health now.
8. Do you feel dentists are efficient, but often seem like they’re in a hurry?
9. Do you feel that dentists do not provide clear explanations?
10. Do you feel that dentists do not really listen to what you have to say?
11. Do you question what the dentist has to say about the work that is needed?
12. Do you feel that dentists make light of your fears?
13. Would you feel embarrassed to interrupt the dental treatment for a moment to rest?
14. Are you aware that Southern Heights Dental Group is specially qualified in Sedation Dentistry for a most comfortable, pain-free dental experience?
Please enter complete the following so we can contact you with information regarding your test results.
Name: Check first name. Check last name
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