Dental patient forms and questionnaires

The forms on this page can help you pinpoint your fears and let your dentist know about them.

They are free to use by anyone, including dental practices.

Dental Fears Patient Form

Dental Fears Patient Form

You can attach this questionnaire when emailing potential dentists, or bring it along to the first get-to-know-you meeting.

It covers your concerns, your previous experiences, and things you think might help.


To help you work out exactly what you are scared of and what might help, you can use these worksheets:

Sample email to dentists

Once you are at a stage where you want to make contact with dentists in your area, you can edit (or totally change!) the following sample email:

You may also like to attach the Dental Fears Patient Form above. If you like, you can add things you may be too embarrassed or nervous to say in person using this form:

Last updated 30 January 2021