FREE dental cleaning questionnaire!
If it’s been more than one year since your last dental cleaning: please answer all of the questions below. I will be using this information to schedule appointments for future cleanings. If you have any questions please don’t hesitate to reach out!
Email: Brenna.mccdental@gmail.com
Phone: (585)749-2995
Thanks in advance!
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Email *
Are you 18 years or older? *
Approximately how long has it been since your last dental cleaning? *
Are you able to sit in a chair for 2.5 hours? *
Please rate your level of calculus based off the following image: *
Captionless Image
What days / times work best for you? You may select multiple options. *
Required
Are you willing to come in for multiple appointments? *
Would you be interested in free X-rays? *
Required
Please provide your name, and the best way to contact you! *
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