What’s Keeping You From The Dentist?Step 1 of 250%1. What Fears Have Made You Avoid The Dentist? (Select All That Apply)1. What Fears Have Made You Avoid The Dentist? Fear Of Pain Fear Of Injections Fear Of Anesthetic Side Effects Fear Of Feeling Helpless/Loss Of Control Fear Of Embarrassment2. Which Of These Causes You Anxiety? (Select All That Apply)2. WHICH OF THESE CAUSES YOU ANXIETY? (SELECT ALL THAT APPLY) Making Your Dentist Appointment Sitting In The Waiting Room Before Your Appointment Sitting In The Dental Chair The Feeling Of Being Judged/Embarrassed The Dentist Walking In The Room3. What Physical Reactions Do You Experience When Having Work Done? (Select All That Apply)3. What Physical Reactions Do You Experience When Having Work Done? (Select All That Apply) Nauseated And/Or Sick To Stomach Increased Breathing Rate Starting To Sweat Increase In Heart Rate Tense Muscles4. Do you Fear Any Of These Situations? (Select All That Apply)4. Do you Fear Any Of These Situations? (Select All That Apply) Your Teeth Being Cleaned Seeing The Anesthetic Needle Feeling The Needle Being Injected Seeing or Hearing The Drill Getting A Filling5. What Work Are You Afraid Of Having Done? (Select All That Apply)5. What Work Are You Afraid Of Having Done? (Select All That Apply) Getting Braces Getting Implants Getting Cavities Filled Getting Crowns Getting Teeth ExtractedContact InfoNameName First Last EmailEmail CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
