Objective: To develop an application for patients, aimed at promoting disease awareness and making evidence-based recommendations to seek professional care or preventive strategies. Materials and Methods: Three expert periodontists identified parameters that, according to the evidence, could represent sociodemographic characteristics, signs, symptoms or medical conditions that can be important to alert the patient about periodontal health. Each parameter was transformed into a self-questionnaire with a single response, which could be completed using a web application. A focus group was convened with professionals and patients who provided feedback on understanding and relevance, and made suggestions for improvement. Results: Several meetings were held to analyze all the possible characteristics/parameters/situations/habits involved in periodontal diseases. The parameters taken into account were bleeding, mobility or loss of teeth due to mobility, gingival recession, visible plaque or calculus, redness or swelling, halitosis, age group to which the patient belongs, frequency of visits to the dentist, diabetes, smoking habit, use of toothpastes, and use of devices for interdental hygiene. To achieve the simplicity of the application, the experts transformed the parameters into 12 questions. Conclusion: The use of this tool in a structured manner helps achieving better patient–professional communication and provides guidance throughout the use of preventive strategies.