Dr. Wada Dentistry specializes in cosmetic and restorative dentistry, and more.

Please tell us about yourself! Dr. Wada will personally respond to your entry.

Our office is dedicated to the belief that all patients, regardless of history and current state of dental breakdown, can be restored to comfort, function, and beauty. Every patient has the opportunity to retain their remaining viable teeth for the rest of their life. All patients who have lost their teeth have the opportunity to have a beautiful, functional replacement.

Your name: (required)
E-mail address: (required)
Date:
What is your number one goal in seeking dental care? (please explain):
Do you have any discomfort in your teeth, jaw joints, face, or chronic headaches? If so, where?
When did your discomfort start?
Have you had regular dental maintenance? If so, by whom?
Do you find going to the dentist stressful? If so, please tell us why, and how we can make your visits here more comfortable.
How many natural teeth do you have?
If you have lost teeth, why did you lose them?
How long ago did you lose your teeth?
Have the spaces where teeth are missing been restored?
If yes, with what type of restoration? (i.e., fixed bridges, removable partials, or dentures, implants).
Are you happy with thte replacement? If not, please explain.
Have you ever been told you have gum disease? If so, when and why?
Do you currently have broken teeth, decay, or infections in your gums or around your teeth? If so, please describe.
Are you happy with the way your teeth look? If not, please explain why.
Please include any other information you think would be helpful.

Do I have T.M.J?

Please take a moment to fill out the following questionnaire. As soon as Dr. Wada receives it, he will either call or email you with his recommendations.

Today's Date:
Your name: (required)
E-mail address: (required)
Phone:
Do you have difficulty opening your mouth?
Do you hear noises from the jaw joints?
Do you have tension or discomfort in or around the ears and cheeks?
Do you have pain on yawning, closing, chewing, or opening wide?
Does the pain feel "dull" or "sharp?"
Does your bite feel "off"?
Have you ever had an injury to your head, neck , or jaw?
Have you ever been treated for "T.M.J"?
If so, please tell us about it.
How long have you had symptoms?
Is there anything else you would like us to know?
My question(s) for Dr. Wada are: