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  1. If you had to go to the dentist tomorrow, how would you feel about it?
    I would look forward to it as a reasonably enjoyable experience.
    I wouldn’t care one way or the other.
    I would be a little uneasy about it.
    I would be afraid that it would be unpleasant and painful.
    So anxious, that I sometimes break out in a sweat or almost feel physically sick.

  2. When you are waiting in the dentist’s office for your turn in the chair, how do you feel?
    Relaxed.
    A little uneasy.
    Tense.
    Anxious
    So anxious, that I sometimes break out in a sweat or almost feel physically sick.

  3. When you are in the dentist’s chair waiting while he gets his drill ready to begin work on your teeth, how do you feel?
    Relaxed.
    A little uneasy.
    Tense.
    Anxious
    So anxious, that I sometimes break out in a sweat or almost feel physically sick.

  4. You are in the dentist’s chair to have your teeth cleaned. While you are waiting and the dentist is getting out the instruments which he will use to scrape your teeth around the gums, how do you feel?
    Relaxed.
    A little uneasy.
    Tense.
    Anxious.
    So anxious, that I sometimes break out in a sweat or almost feel physically sick.
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    29 WEST DENTAL ASSOCIATES
    29 West 57th Street, 6th Floor
    New York, N.Y. 10019
    Ph (212) 838-2900
    Fax (212) 935-4703