Dr. Krochak: Corah's Dental Anxiety Scale

Corah's Dental Anxiety Scale

Please fill out all these forms before your first visit:
☐ Medical History Form
☐ Patient Account Information
☐ Appointment Preference Form
☐ Corah's Dental Anxiety Scale
☐ Mount Sinai Dental Fear Inventory



First Name		Last Name

Home Phone		Work Phone

Email

If you had to go to the dentist tomorrow, how would you feel about it? I would look forward to it as a reasonably enjoyable experience. I wouldn't care one way or the other. I would be a little uneasy about it. I would be afraid that it would be unpleasant and painful. So anxious, that I sometimes break out in a sweat or almost feel physically sick.

When you are waiting in the dentist's office for your turn in the chair, how do you feel? Relaxed A little uneasy Tense Anxious So anxious, that I sometimes break out in a sweat or almost feel physically sick

When you are in the dentist's chair waiting while he gets his drill ready to begin work on your teeth, how do you feel? Relaxed A little uneasy Tense Anxious So anxious, that I sometimes break out in a sweat or almost feel physically sick

You are in the dentist's chair to have your teeth cleaned. While you are waiting and the dentist is getting out the instruments that he will use to scrape your teeth around the gums, how do you feel? Relaxed A little uneasy Tense Anxious So anxious, that I sometimes break out in a sweat or almost feel physically sick