Your age range.

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. .1 - How much do you agree with the following statements?

A. I feel anxious shortly before going to the dentist.
B. I generally avoid going to the dentist because I find the experience unpleasant or distressing.
C. I get nervous or edgy about upcoming dental visits.
D. I think that something really bad would happen to me if I were to visit a dentist.
E. I feel afraid or fearful when visiting the dentist.
F. My heart beats faster when I go to the dentist
G. I delay making appointments to go to the dentist.
H. I often think about all the things that might go wrong prior to going to the dentist.

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. .2 - Do the following statements apply to you ?

A. Going to the dentist is actively avoided or else endured with intense fear or anxiety.
B. My fear of going to the dentist has been present for at least 6 months.
C. My fear, anxiety or avoidance of going to the dentist significantly affects my life in some way (dental pain, avoid eating some foods, embarrassed or self-conscious about appearance of teeth or mouth, etc).
D. I am afraid of going to the dentist because I am concerned I may have a panic attack (abrupt fear with sweating, pounding heart, fear of dying or losing control, chest pain etc.)
E. I am afraid of going to the dentist because I am generally highly self-conscious or concerned about being watched or judged in social situations.

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. .3 - To what extent are you anxious about the following things when you go to the dentist ?

A. Painful or uncomfortable procedures.
B. Feeling embarrassed or ashamed.
C. Not being in control of what is happening.
D. Feeling sick, queasy or disgusted.
E. Numbness caused by the anaesthetic.
F. Not knowing what the dentist is going to do.
G. The cost of dental treatment.
H. Needles or injections.
I. Gagging or choking.
J. Having an unsympathetic or unkind dentist.