questionnaire

We are happy to have you join our great family of patients and friends. The benefits of a healthy, beautiful smile are immeasurable, and our goal is to allow you to obtain the healthy teeth and attractive smile you want and deserve. Please complete this form so we can provide the best care possible for you. Thank you!

Dental History

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What prompted you to call our office for an appointment?

When was the last time you were seen by a dentist?

Previous dentist's name?

As a child, did you have a lot, average, or very little tooth decay?

If so, what is the origin of your anxiety?

As you come into a new dental practice, what are your expectations, concerns, and/or priorities?

Dentally, what would you like to achieve? What does the "finish line" look like?

If you could wave a magic wand and change anything about the appearance of your smile, what would you like to do?