Tell us where you're at

No judgment — roughly one in five people feels this way.

How anxious are dental visits for you?

Mildly nervous Quite anxious Very anxious — I delay booking Phobic — I've avoided care for years

What's hardest for you?

Needles / freezing The drill (sound or feeling) Gagging Feeling out of control Past bad experience Embarrassment about my teeth The unknown

Which option interests you?

Nitrous oxide (laughing gas) Oral sedation (deeper relaxation) Not sure — recommend for me Just the 5-minute nitrous trial first

Safety screening

These questions determine which options are safe for you — please answer carefully.

Do you have any of these conditions?

COPD Emphysema Asthma Other chest / breathing problems Sleep apnea Multiple sclerosis Claustrophobia None of these

Thanks for flagging this — nitrous oxide isn't suitable with COPD, but other comfort options may be. We'll discuss alternatives when we review your assessment.

Current medications

Include everything — sedatives interact with many medications. Write 'none' if none.

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Are you pregnant or possibly pregnant?

Not applicable No Yes

For oral sedation dosing — are you comfortable providing weight at your visit?

Yes Prefer to discuss in person

How do we reach you?

First name

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Last name

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Phone

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Email

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Anxious about phone calls too? We get it.

Call me Text me first Email me

Dr. Grewal holds an Oral Moderate Sedation certificate (Academy of General Dentistry). Learn more about how our sedation options work.

Sedation Assessment

Tell us where you're at

Safety screening

How do we reach you?

Thank You — We've Got It!