SimplyBe™ Understanding Form

SimplyBe™ Understanding Form

Every child experiences dental visits differently, and that’s completely okay.This form helps us better understand your child’s comfort, preferences, and needs so we can create the safest and most supportive experience possible
Child Profile
Child’s Name
Preferred Nickname
Age
Email
example@example.com
Preferred Language
Emotional Experience
How does the child usually feel about dental visits?
Has the child had any difficult or upsetting dental visits before?
What situations may make the child feel uncomfortable or overwhelmed?
Sensory Understanding
Which sensory sensitivities does the child have?
What usually helps the child feel calm or safe?
Communication Preferences
What communication style helps your child best?
Parent Collaboration
What would help us make your child feel safest during their visit?
Positive Reinforcement
What motivates or encourages your child?
Should be Empty: