Patient Risk Assessment Form

Because you deserve to be cavity-free!

  • Find out if you have signs and symptoms of the caries infection
  • Learn whether you are at risk for cavities, even if you don't currently have them
  • Understand what you can do to lower your risk for decay

Just as a doctor reviews a patient's risk for heart disease by assessing diet, exercise habits, and blood pressure, your dentist will review lifestyle habits, dental hygiene, and other risk factors for cavities. This simple, one-minute questionnaire covers such risk factors as diet, dental hygiene, saliva flow, medications, bacterial population, and dental history to identify specific risk factors for cavities.