Name *

I’ve had a bad dental experience in the past

My time is in demand – please don’t keep me waiting

I get really cold in the dental chair

I want to know every aspect of my treatment before you do it

I don’t want to know about the details, just do it!

I find it hard to hold my mouth open for so long

I get a reaction to the anaesthetic

I have a strong gag reflex

I get uncomfortable in dental chairs

I want to feel in control of my treatment appointment

Finances are a concern for me; please tell me about my options

I get nervous around needles

I don’t like the sound of the drill

I get nervous with the smell of the dental practice

Or, tell us something else about how you feel: