Dental Anxiety Help Question Title * 1. What is the nature of your Dental anxiety fear of pain fear of unknown past bad experience tools in mouth people crowding in around me Other (please specify) OK Question Title * 2. How do you experience this anxiety? Where do you feel it? As tension in a specific place in your body? physical sensations like heart rate or sweating general all over Other (please specify) OK Question Title * 3. How has, or is, this affecting your life? it causes days/weeks of anxiety when I know I have to go to the dentist my dental health has negatively affected other areas of my health It has caused social embarrassment It causes days or weeks of pain afterwards from being in the chair Other (please specify) OK Question Title * 4. Can you effectively manage your anxiety now? Can you get in for regular care? Yes No sometimes Other (please specify) OK Question Title * 5. What would it mean to you if you were free of this? I could get the care I know I need my health would improve I'd feel so relieved I'd be so proud of myself Other (please specify) OK Question Title * 6. would you be interested in: A guided self help program part self guided/ part group coaching a live work shop an online video group coaching event private coaching Other (please specify) OK Question Title * 7. If home care is also difficult, what is the issue Brushing makes my skin crawl I hate flossing my gums are too tender Other (please specify) OK Question Title * 8. Is it embarrassing to even talk about this? yes, I feel like it's my fault no, I know lots of people experience this I don't talk about it with my friends I don't even talk to my dentist about it Other (please specify) OK Question Title * 9. Are you 2nd or 3rd generation of your family living in the US? (Dental health varies widely from country to country) I do as my family has I have adopted American dental health practices Other (please specify) OK Question Title * 10. Have you always been afraid of dental care? Yes, for as long as I can remember no, I had a bad experience Not until I had other issues that made getting dental care harder (like TMJ, or neck/back issues) I was fine and then one day out of the blue I just couldn't go and I don't know where the fear came from OK DONE