{"id":23913,"date":"2025-09-03T14:34:20","date_gmt":"2025-09-03T12:34:20","guid":{"rendered":"https:\/\/dev.lp-form.com\/al-alem\/?page_id=23913"},"modified":"2025-12-16T13:34:37","modified_gmt":"2025-12-16T11:34:37","slug":"family-dental-questionnaire","status":"publish","type":"page","link":"https:\/\/al-alem.com\/en\/build-your-teeth\/family-dental-questionnaire\/","title":{"rendered":"Family Dental Questionnaire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"23913\" class=\"elementor elementor-23913\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3eb07b76 e-flex e-con-boxed e-con e-parent\" data-id=\"3eb07b76\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ee5aeb4 elementor-widget elementor-widget-heading\" data-id=\"ee5aeb4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\"><span style=\"color: #999999\">Family<\/span>   Dental Questionnaire\n\n\n<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e6520c5 elementor-widget elementor-widget-heading\" data-id=\"2e6520c5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">This questionnaire will help us understand your family's dental needs and provide tailored information about our family dental services.\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6aaacc0 e-flex e-con-boxed e-con e-parent\" data-id=\"6aaacc0\" data-element_type=\"container\" data-e-type=\"container\" id=\"family\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ab40535 elementor-widget elementor-widget-shortcode\" data-id=\"ab40535\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style id=\"wpforms-css-vars-23921\">\n\t\t\t\t#wpforms-23921 {\n\t\t\t\t--wpforms-field-border-radius: 0px;\n--wpforms-field-border-color: #cccccc;\n--wpforms-field-border-color-spare: #cccccc;\n--wpforms-field-text-color: #444444;\n--wpforms-label-color: #262626;\n--wpforms-label-sublabel-color: #7f7f7f;\n--wpforms-label-error-color: #ff0000;\n--wpforms-button-border-style: solid;\n--wpforms-button-border-radius: 0px;\n--wpforms-button-background-color: #dddddd;\n--wpforms-button-border-color: #cccccc;\n--wpforms-button-text-color: #666666;\n--wpforms-page-break-color: #dddddd;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 14px;\n--wpforms-label-size-line-height: 17px;\n--wpforms-label-size-sublabel-font-size: 13px;\n--wpforms-label-size-sublabel-line-height: 16px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-23921\"><form id=\"wpforms-form-23921\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"23921\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/23913\" data-token=\"33cdecf41dc0cfd4fe430ea174c2d2c5\" data-token-time=\"1776180009\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-23921-field_1-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Who in your family needs dental care? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-23921-field_1\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_1_1\" name=\"wpforms[fields][1][]\" value=\"Children (under 12): I am looking for dental care for my child\/children.\" aria-errormessage=\"wpforms-23921-field_1_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_1_1\">Children (under 12): I am looking for dental care for my child\/children.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_1_2\" name=\"wpforms[fields][1][]\" value=\"Teens (12-18): I am looking for dental care for my teenager\/teenagers.\" aria-errormessage=\"wpforms-23921-field_1_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_1_2\">Teens (12-18): I am looking for dental care for my teenager\/teenagers.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_1_3\" name=\"wpforms[fields][1][]\" value=\"Adults (18+): I am looking for dental care for myself or other adults in my family.\" aria-errormessage=\"wpforms-23921-field_1_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_1_3\">Adults (18+): I am looking for dental care for myself or other adults in my family.<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_1_4\" name=\"wpforms[fields][1][]\" value=\"Entire Family: I am looking for a dental practice that can cater to the entire family, from children to adults.\" aria-errormessage=\"wpforms-23921-field_1_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_1_4\">Entire Family: I am looking for a dental practice that can cater to the entire family, from children to adults.<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_1_5\" name=\"wpforms[fields][1][]\" value=\"Unsure: I&#039;m not sure who needs care, or I have a general inquiry.\" aria-errormessage=\"wpforms-23921-field_1_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_1_5\">Unsure: I'm not sure who needs care, or I have a general inquiry.<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-23921-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-23921-field_3\" >you family needs<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-23921-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-23921-field_2-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">What type of dental services are you primarily interested in for your family? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-23921-field_2\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_2_1\" name=\"wpforms[fields][2][]\" value=\"Preventive Care: Routine check-ups, cleanings, and fluoride treatments.\" aria-errormessage=\"wpforms-23921-field_2_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_2_1\">Preventive Care: Routine check-ups, cleanings, and fluoride treatments.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_2_2\" name=\"wpforms[fields][2][]\" value=\"Restorative Dentistry: Fillings, crowns, or treatment for cavities.\" aria-errormessage=\"wpforms-23921-field_2_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_2_2\">Restorative Dentistry: Fillings, crowns, or treatment for cavities.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_2_3\" name=\"wpforms[fields][2][]\" value=\"Orthodontics: Braces or aligners for teeth straightening.\" aria-errormessage=\"wpforms-23921-field_2_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_2_3\">Orthodontics: Braces or aligners for teeth straightening.<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_2_4\" name=\"wpforms[fields][2][]\" value=\"Cosmetic Dentistry: Whitening, veneers, or other aesthetic improvements.\" aria-errormessage=\"wpforms-23921-field_2_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_2_4\">Cosmetic Dentistry: Whitening, veneers, or other aesthetic improvements.<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_2_5\" name=\"wpforms[fields][2][]\" value=\"Emergency Care: Urgent treatment for dental pain, injury, or infection.\" aria-errormessage=\"wpforms-23921-field_2_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_2_5\">Emergency Care: Urgent treatment for dental pain, injury, or infection.<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-23921-field_2_6\" name=\"wpforms[fields][2][]\" value=\"General Consultation: I want to discuss general dental health or specific concerns.\" aria-errormessage=\"wpforms-23921-field_2_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-23921-field_2_6\">General Consultation: I want to discuss general dental health or specific concerns.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-23921-field_7-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"7\" style=\"display:none;\"><div id=\"wpforms-23921-field_7\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-23921-field_7-error\"><p><span style=\"font-weight:400\">For children under 12, preventive care is crucial for establishing healthy oral habits. Our pediatric dental services focus on gentle cleanings, fluoride applications, and sealants to protect young teeth from cavities. We create a fun and welcoming environment to make dental visits a positive experience for your child.<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-23921-field_8-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"8\" style=\"display:none;\"><div id=\"wpforms-23921-field_8\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-23921-field_8-error\"><p><span style=\"font-weight:400\">Teenagers often benefit from orthodontic evaluations. We offer various orthodontic solutions, including traditional braces and clear aligners, to correct misaligned teeth and bites. Early intervention can prevent more complex issues later, leading to a confident and healthy smile for your teen.<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-23921-field_9-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"9\" style=\"display:none;\"><div id=\"wpforms-23921-field_9\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-23921-field_9-error\"><p><span style=\"font-weight:400\">Teenagers often benefit from orthodontic evaluations. We offer various orthodontic solutions, including traditional braces and clear aligners, to correct misaligned teeth and bites. Early intervention can prevent more complex issues later, leading to a confident and healthy smile for your teen.<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-23921-field_10-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"10\" style=\"display:none;\"><div id=\"wpforms-23921-field_10\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-23921-field_10-error\"><p><span style=\"font-weight:400\">Our practice is designed to be a one-stop solution for all your family's dental needs. We offer a wide range of services for all ages, ensuring continuity of care and convenience. A general consultation will allow us to discuss your family's specific needs and create a personalized dental plan that works for everyone.<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-23921-field_11-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"11\" style=\"display:none;\"><div id=\"wpforms-23921-field_11\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-23921-field_11-error\"><p><span style=\"font-weight:400\">If you have a general inquiry or require emergency dental care, please contact our Clinics immediately. We prioritize urgent cases and will do our best to schedule you for the earliest possible appointment. For general questions, our team is happy to provide information and guidance to help you make informed decisions about your family's dental health.<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-23921-field_3-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-23921-field_3-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-23921-field_3-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v3\" ><input type=\"hidden\" name=\"wpforms[recaptcha]\" value=\"\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"23921\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/pages\/23913\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-23921\" class=\"wpforms-submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Book Appointment<\/button><img decoding=\"async\" src=\"https:\/\/al-alem.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Family Dental Questionnaire This questionnaire will help us understand your family&#8217;s dental needs and provide tailored information about our family dental services.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":23859,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-23913","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/pages\/23913","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/comments?post=23913"}],"version-history":[{"count":5,"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/pages\/23913\/revisions"}],"predecessor-version":[{"id":24881,"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/pages\/23913\/revisions\/24881"}],"up":[{"embeddable":true,"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/pages\/23859"}],"wp:attachment":[{"href":"https:\/\/al-alem.com\/en\/wp-json\/wp\/v2\/media?parent=23913"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}