Do you fill ill at the thought of going to the dentist?

 yes      no

    

 

You lose sleep for the excitement the night before or a few nights before a visit to the dentist?

 yes      no

    

 

See your dentist you crying cause of crisis or increased heart beats?

 yes      no

    

 

Do you feel taken by panic when the dentist puts in your mouth instruments during a visit?

 yes      no

    

 

Feeling choke or suffocate during a dental visit?

 yes      no

    

 

You lose control when you're subjected to a procedure for dental care?

 yes      no

    

 

Are you afraid of pain?

 yes      no

    

 

Are you afraid of the noise of the drill?

 yes      no