ANXIETY QUESTIONAIRRE.

FORM 1

NAME; -------------------------------------------------- PH NO;

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AGE; ------------------------------ GENDER;

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Education; ------------------------------ Reason of stress

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1. How are you feeling just now sitting on the dental chair?
a. most relaxed
b. mildly fearful
c. moderately fearful
d. severely fearful
e. extremely fearful.

2. What are your feelings regarding your braces?

a. most relaxed
b. mildly fearful
c. moderately fearful
d. severely fearful
e. extremely fearful.

3. Are you anxious about extractions involved in treatment?

 a. most relaxed
b. mildly fearful
c. moderately fearful
d. severely fearful
e. extremely fearful.

4. How much you are anxious about pain related to treatment?

a. most relaxed
b. mildly fearful
c. moderately fearful
d. severely fearful
e. extremely fearful.

5. How much you are anxious about what is going to happen next.?

a. most relaxed
b. mildly fearful
c. moderately fearful
d. severely fearful
e. extremely fearful.