Nice to meet you WE ARE CURRENTLY WELCOMING NEW PATIENTS AT WATERMARK. tHE questionnaire BELOW WILL HELP US GET TO KNOW MORE ABOUT YOU AND WHAT YOU ARE LOOKING FOR IN A NEW DENTAL HOME. wE LOOK FORWARD TO MEETING YOU IN PERSON! Name * First Name Last Name Best Phone Number to Reach You * (###) ### #### Email where we can send correspondence * Dental Insurance (We are out of network with all dental insurances, but we will file for you.) Please list all dental coverage How did you hear about our office? * Have you ever been to a Periodontist or been told you have periodontal disease? * In the last 2 years how often have you gotten your teeth cleaned? * --choose one-- Every 3 months Every 4 months Every 6 months It's been a while Tell us about any current or past TMJ problems Do you wear a night guard or has anyone recommended something for grinding your teeth? We start all new patients with a full set of x-rays. Do you feel you have a recent set of x-rays you’d like us to review prior to your first visit? * Please rate how you feel the following statements apply to you. * My oral health is a priority to me Strongly Disagree Disagree Neutral Agree Strongly Agree Cost is the most important factor in my dental decisions Strongly Disagree Disagree Neutral Agree Strongly Agree Routine preventative x-rays and examinations are important to help prevent undetected problems in my mouth Strongly Disagree Disagree Neutral Agree Strongly Agree I like having my teeth cleaned Strongly Disagree Disagree Neutral Agree Strongly Agree I am looking for more information about the following treatments Invisalign Cosmetic Veneers or Crowns TMJ Treatment Implants Anything else you would like us to know Thank you! Your form has been submitted, what can you expect next?Someone from our team will reach out to you if you need to get xrays or other correspondence from another dental office. Your first visit with us will consist of a comprehensive exam with one of our hygienists and one of our doctors. Unless you have a recent (<3 years) full set of xrays we would take those xrays at that visit. We will scan your mouth with a camera that will allow us to ahve a 3D model of your teeth- this allows us to more easily talk about things that we see in your mouth, and it provides an important record should anything change in your mouth going forward. At your first visit we will make a plan for your future visits including what you would need more maintenance recalls and any treatment that you may need or want. You'll have time to ask us questions about anything that's on your mind, plus anything that comes up during your visit with us. We are looking forward to meeting you!
