Preventive Care Questionnaire
Office Information
Your name
*
Your email address
*
Doctor or office name
*
Office phone number
*
Destination URL
*
Please enter where you would like this content to live on your website.
Would you like to view/edit the content before it's uploaded?
*
Yes
No
General Information
Why do patients need regular cleanings and checkups? What do you look for/accomplish during these visits?
What kind of diet do you recommend to maintain good oral health?
What should patients avoid to maintain good oral health?
Your Experience
What services or products do you provide to help patients prevent cavities and gum disease?
What makes getting preventive dentistry at your office different from being treated at another office? What makes you unique?
Additional Information that could set you apart from your competition?
Do you have any patient testimonials (text or videos) or videos you have created for your practice or the treatments you offer? (Include a link to any YouTube videos you’ve created!)
Do you have before and after photos? If so, please attach them here
Upload Files
Cancel
of
Save
Submit
Should be Empty: