Dental SurveyDental Survey How often do you visit the dentist?QuarterlyEvery 6 monthsYearlyEmergency basisOtherWhat is your main dental concern?Pain or DiscomfortCosmetics relatedGeneral CheckupWhich age group do you fall?20 and under21 - 4041 - 6061 and overWhat do you value more in a dentist?AffordabilityQuality of workPain-free procedureLasting patient-doctor relationshipHow would you categorize your current dental condition?GoodFairBadHopelessWhen you visit your dentist do you require:Oral sedationIV sedationNothingIs there a specific procedure you’re looking for?Full NamePhoneEmailΔ
