Seattle Cosmetic Dentist - Advanced Cosmetic Laser Dentistry

Please complete each of the following three new patient forms listed below prior to your initial visit.

· Tell us About You

· Questionnaire

· Health History

If you'd rather bring the forms with you to your appointement, please download and print the following PDF forms.

· Tell us About You (PDF)

· Questionnaire {PDF)

· Health History (PDF)

Tell us About You

The better we understand you, the better we can serve you. Please make a mark along each scale below to indicate your opinion or preference.

I know a great deal about my dental condition					I know very little about my dental condition
I like to be presented with fewer options					I like to be presented with more options
I tend to look at the details					I tend to look at the big picture
I prefer long lasting solutions which may initially cost more					I prefer temporary solutions at lower cost
I prefer to talk in technical terms with my dentist					I prefer to talk in non-technical terms
My insurance largely determines the extent of my care					I largely determine the extent of my care
I prefer to wait until I must act					I usually see no reason to delay care
I rely more on self-maintenance					I rely on more professional maintenance
I like newer and more modern techniques					I like tried and true methods

In order of importance, I generally consider the following benefits (Please rank 1-7 or 8):

Comfort

Function

Health

Appearance

Precision

Peace of Mind

Durability

Other

In order of importance, I generally weigh the following in making a decision regarding my dental health (Please rank 1 through 5 or 6):

Money

Time

Personal Effort

Physical Discomfort

Fear/Anxiety

Other