1 | What age was your child at their very first dental visit: |
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2 | What first motivated you to bring them to the dentist? |
3 | Where did your child attend the dentist? |
4 | What concerned you most about your child’s teeth? Please Rank from 1–6 (1 being of most concern and 6 of least concern): Function; Speech; Reaction of other children; Reaction of other parents; Your child’s reaction (self-conscious); How the teeth look |
5 | In your opinion, has your child ever been self-conscious about their teeth? If yes, please specify at what age? |
6 | How many dental visits has your child had? Response options: Less than 5 visits/5–10 visits/10–20 visits/20 or more visits |
7 | Was your child cooperative for dental visits? If you answered ‘No’, Why do you think your child was not cooperative? |
8 | Where did you get information about your child’s dental condition? Did you receive enough information? |
9 | Please specify what additional Information needed: |
10 | If you could start from the beginning again, what would you change? |