New Patient Questionnaire New Patient Questionnaire Name First Last How long has it been since your last cleaning and which office are you transferring from? Are you in any dental pain? If so, how long has it been happening? Which area(s) of the mouth? How do you feel about the overall appearance, alignment, and color of your teeth? Have you had any braces/orthodontic treatment? Do you have any other concerns about your teeth or future care? Δ
