Request a Demo

Book a Demo with Zonka Feedback

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 this template.

Understanding Dental Health History Questionnaire

Use this template to ask your patients about their hygiene habits and when they last visit the health clinic. This questionnaire will help you with your first appointment and prepare your patients well for the check-up.

To create a Dental Health History Questionnaire, just sign up or sign in to Zonka Feedback. You’ll be able to choose this questionnaire when you begin creating your feedback form or survey. Customize it today and start sharing!

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?

Sign Up on Zonka Feedback for free and implement this Dental Health History Questionnaire Template in your account today!

Create and send this Dental Health History Questionnaire

Get Started