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Willow Point Dental P.C.


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Welcome to our practice!! We appreciate the opportunity to serve your oral healthcare needs. Please help us understand your views regarding your dental care.

New Patient Discovering Values

What is most important to you about the dental care you receive?

(These are some common responses we hear to this question: “I want to keep my teeth forever.” “I never want to be in pain.” “ I want a beautiful smile.” “I want to be able to comfortably chew and taste my food.” )
What made you decide to leave your last dental office?
What else do you want to share with the doctor about your care and/or needs?
If you could wave a magic wand and change your smile, what would you change?
Have you ever considered correcting crooked teeth? Yes No
Are you aware that invisible, removable braces are available for adults? Yes No
Does this interest you? Yes No
Do you have dark fillings that you would like to have replaced with tooth colored fillings? Yes No
Have you ever experienced anxiety while in the dental chair? Yes No
Have you ever avoided going to the dentist because of your fear of the dentist or hygienist? Yes No
Are there times when you wish you could look forward to your dental visit as a truly relaxing experience? Yes No
In our office, we have invested in an advanced technology called NuCalm, which is proven to create a relaxing dental experience.
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(Your digital signature (full name) is as legally binding as a physical signature.)