Online Dental Consultation

1. Describe your concern or symptoms
 

2. Is the tooth or the affected area sensitive to cold?
  Yes No

3. Is the tooth or that area senstivive to hot?
  Yes No

4. Are you able to pin point exactly to which tooth is hurting?
  Yes No

5. Do you have pain when you chew?
  Yes No

6. Do you have pain when you fully bit down without food or objects?
  Yes No

7. When you push on the tooth or area is it painful or uncfortable?
  Yes No

8. When you push the tooth or the area does it releive the pain?
  Yes No

9. Does the tooth feel loose?
  Yes No

10. Are any of your teeth loose?
  Yes No

11. Have you had any recent dental treatment?
  Yes No

What did you have done?
 

12. Does the pain persist long after the source of cold or heat is removed?
  Yes No

13. Attach Files
You may attach any xrays or pictures in digital format

                 

Name:              
Phone Number:
Email Address: 

All responses are limited opinions of a dentist due to the limited nature of online consultaion. Good ideas and suggestions may be given but it is always advised to physically see a dentist for a thorough and complete exam for your concerns. If you do not have a dentist we welcome you to see our talented group of dentists and specialists. Many patients have found this to be helpful in going forward with their treatments and finding a dentist.
I Agree