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PROMS Survey for Root Canal Treatment (Before)
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proms survey for rootcanaltreatment before
Page Content
Patient-Reported Outcome Measures for Root Canal Treatment (Before)
2 mins
estimated time to complete
Instructions
Thank you for choosing to have your treatment done at the National Dental Centre Singapore. As part of our efforts to continuously improve our service, we would like to find out about your experience with us.
Please answer the following questions by choosing the most relevant option on the scale.
Visit Date
This is a required field.
Please enter a valid date.
4 Digit Queue Ticket Number
This is a required field.
Root Canal Tooth Number
This is a required field.
Please choose only
one
response for each question. Thank you!
SECTION A. AREAS OF CONCERN FOR ENDODONTIC TREATMENT
1. On a scale of 0-10, please rate the degree of pain you are currently experiencing from the tooth.
0
1
2
3
4
5
6
7
8
9
10
This is a required field.
Prior to receiving endodontic treatment in National Dental Centre Singapore:
2. Have you had trouble pronouncing any words because of problems with the tooth?
Never
Hardly ever
Occasionally
Fairly often
Very often
This is a required field.
3. Have you found it uncomfortable to eat any foods because of problems with the tooth?
Never
Hardly ever
Occasionally
Fairly often
Very often
This is a required field.
4. Have you felt self-conscious because of problems with the tooth?
Never
Hardly ever
Occasionally
Fairly often
Very often
This is a required field.
5. Have you had difficulty doing your usual jobs because of problems with your tooth?
Never
Hardly ever
Occasionally
Fairly often
Very often
This is a required field.
6. Have you felt that life in general was less satisfying because of problems with the tooth?
Never
Hardly ever
Occasionally
Fairly often
Very often
This is a required field.
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