My office has found it useful to provide a dental history and smile evaluation form to incoming patients to fill out on their first visit. This gives us a good idea from the first visit what dental anxieties and desires our patients have. Since patients also have to fill out general contact and insurance information, we always try to point them to our website to download our forms before they come in. This gives patients the opportunity to become familiar with our office while browsing our website and to fill out the paperwork when they have more time at home.
Our Smile Evaluation contains the following questions:
1. Are you unhappy with your teeth and their appearance?
2. Do you think you have active decay or gum disease?
3. Does food catch between your teeth?
4. Do you have old fillings or dental work that you need replaced?
5. If you could change one thing about your smile what would it be?
6. If we could offer you a simple, inexpensive way to whiten your teeth would you be interested?
7. How would you like your teeth to look in 15 years?
The Dental History portion of our new patient form contains these questions:
1. Do you feel nervous about dental treatment?
2. What can we do to alleviate your nervousness?
3. Have you ever had a bad experience in a dental office?
4. What can we do to make this experience better?