Mount Sinai Dental Fear Inventory

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
Please rate the following situations on a scale of 1-100
Where 1 is so relaxed you could fall asleep, and 100 is the point where you are about to faint or become sick.