| never | once or twice | a few times | often | nearly always | |
|---|---|---|---|---|---|
| 1. Has fear of dental work ever caused you to put off making an appointment? | 1 | 2 | 3 | 4 | 5 |
| 2. Has fear of dental work ever caused you to cancel or not appear for an appointment? | 1 | 2 | 3 | 4 | 5 |
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