Dental Health History Questionnaire

Want to know about your patient's dental health? Ask them about their hygiene habits and analyze their dental health history using a dental history questionnaire.

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How does this Dental Health History Questionnaire help?

This dental history questionnaire is for the use of dental professionals or dental clinics to collect detailed history about your patients. This template allows the clinics to know patient's issues in the past such as bad breath, bleeding gums, grinding teeth and more. And finally the reason for their next visit as well. So, it is an overall and quick way to know about your patients beforehand making it easier to operate.

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How to Use this Dental History Template?

Are you tired of busy waiting rooms? By using Zonka Feedback’s Dental History Template you’ll be able to cycle through appointments with ease. This template works and looks well on any device, be it kiosk, iPad or Andorid tablet. You can easily share it on your website or share it via email by using a survey link. So, say bye to the paperwork and start taking quick feedback.

4 Questions

4Screens

30 secs to complete

List of Dental Health History Questions

The following questions are included in the Dental Health History Questionnaire Template:

What's your full name?
What's your date of birth?
Please select any of these issues you've experienced in the past.
What's the reason for your next visit?

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FAQs about Dental Health History Questions

1. Why it is important to take dental history?

A thorough dental history can aid significantly in treatment planning, case selection and malpractice defense. It allows the clinics to know the basic history of the patient and the best way possible to operate the patients.

2. Where can I use this Dental History Questionnaire?

You can use a QR code at your touchpoint. Another method is to send an email or SMS survey to the customer once the service is completed. If you don't have access to the internet, you can conduct offline surveys using kiosks, mobile devices, or tablets.

Create and send this Dental Health History Questionnaire