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1. What is the reason for today’s visit?
2. How frequently do you see a dentist?
5. Are your teeth sensitive to:
6. Do your gums bleed when
7. Do your gums feel swollen or tender?
8. Do you have bad breath or bad taste in your mouth?
9. Do your jaws crack, pop or grate when you open widely?
10. Do you grind or clench your teeth?
11. Do you have food catch between your teeth?
12. Have you ever had local anaesthetic (freezing)?
Any complications
13. Have you ever had any problems with your previous dental treatments?
13. Have you ever had any problems with your previous dental treatments?
14. Have you ever had any of the following
Are you satisfied with your teeth
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