Corah's Dental Anxiety Scale

Please make certain to fill out all five forms before you come for your first visit so that we can spend your entire first visit diagnosing your dental condition and mutually establish the trusting, caring relationship we value having with all our patients.

  1. Medical History Form
  2. Patient Account Information
  3. Corah's Dental Anxiety Scale
  4. Mount Sinai Dental Fear Inventory
  5. No Show & Cancellation Policy

Name *
Name
Home Phone *
Home Phone
Work Phone
Work Phone
If you had to go to the dentist tomorrow, how would you feel about it?
When you are waiting in the dentist's office for your turn in the chair, how do you feel?
When you are in the dentist's chair waiting while he gets his drill ready to begin work on your teeth, how do you feel?
You are in the dentist's chair to have your teeth cleaned. While you are waiting and the dentist is getting out the instruments that he will use to scrape your teeth around the gums, how do you feel?